AN ACT CONCERNING AN EQUITABLE MEDICAID AUDIT, BILLING AND REIMBURSEMENT POLICY FOR PHARMACIES.

HB 6091 requires Connecticut's Department of Social Services to stop denying Medicaid pharmacy reimbursements based on data extrapolation from minor clerical or technical errors in audits. It mandates that pharmacies receive confirmation of all notices (like billing alerts) and creates a real-time, accessible database showing which drugs are approved for the state's preferred drug list. The bill also establishes a formal grievance process by October 1, 2025, allowing pharmacies to challenge reimbursements that don't cover their actual cost to dispense drugs to Medicaid patients. This directly affects community pharmacies participating in Connecticut's Medicaid program.