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S.D. Codified Laws § 58-29E-13

Certain claims adjustments prohibited

Source: SL 2019, ch 213, § 2; SL 2023, ch 166, § 13.

A pharmacy benefit manager may not, directly or indirectly, retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless:

(1) The adjustment is necessitated by a pharmacy audit conducted in accordance with chapter 58-29F;

(2) The adjustment is necessitated by a technical billing error;

(3) The original claim was found to have been fraudulently submitted; or

(4) The claim submission was a duplicate for which the pharmacy had already received payment.

Official source: South Dakota Legislature. Reproduced from public-domain South Dakota statutes; confirm against the official source for the current text. Not legal advice.