Legislation
SECTION 2906
Licensing of a pharmacy benefit manager
Insurance (ISC) CHAPTER 28, ARTICLE 29
§ 2906. Licensing of a pharmacy benefit manager. (a) The
superintendent may issue a pharmacy benefit manager's license to any
person, firm, association or corporation who or that has complied with
the requirements of this article, including regulations promulgated by
the superintendent. The superintendent, in consultation with the
commissioner of health, shall establish, by regulation, minimum
standards for the issuance of a license to a pharmacy benefit manager.
(b) The minimum standards established under this subsection shall
contain both prerequisites for the issuance of a license and
requirements for maintenance of a license and shall address, without
limitation:
(1) conflicts of interest between pharmacy benefit managers and health
plans or insurers;
(2) deceptive practices in connection with the performance of pharmacy
benefit management services;
(3) anti-competitive practices in connection with the performance of
pharmacy benefit management services;
(4) unfair claims practices in connection with the performance of
pharmacy benefit management services;
(5) pricing models used by pharmacy benefit managers both for their
services and for the payment of services to the pharmacy benefit
manager;
(6) standards and practices used in the creation of pharmacy networks
and contracting with network pharmacies and other providers, including
promotion and use of independent and community pharmacies and patient
access and minimizing excessive concentration and vertical integration
of markets; and
(7) protection of consumers.
(c) For each business entity, the officer or officers and director or
directors named in the application shall be designated responsible for
the business entity's compliance with the insurance laws, rules and
regulations of this state.
(d)(1) Before a pharmacy benefit manager's license shall be issued or
renewed, the prospective licensee shall properly file in the office of
the superintendent an application therefor in such form or forms and
supplements thereto as the superintendent prescribes, and pay a fee of
eight thousand dollars for each year or fraction of a year in which a
license shall be valid.
(2) Every pharmacy benefit manager's license shall expire thirty-six
months after the date of issue. Every license issued pursuant to this
section may be renewed for the ensuing period of thirty-six months upon
the filing of an application in conformity with this subsection.
(e) If an application for a renewal license shall have been filed with
the superintendent at least two months before its expiration, then the
license sought to be renewed shall continue in full force and effect
either until the issuance by the superintendent of the renewal license
applied for or until five days after the superintendent shall have
refused to issue such renewal license and given notice of such refusal
to the applicant.
(f) The superintendent may refuse to issue a pharmacy benefit
manager's license if, in the superintendent's judgment, the applicant or
any member, principal, officer or director of the applicant, is not
trustworthy and competent to act as or in connection with a pharmacy
benefit manager, or that any of the foregoing has given cause for
revocation or suspension of such license, or has failed to comply with
any prerequisite for the issuance of such license.
(g) Licensees and applicants for a license under this section shall be
subject to examination by the superintendent as often as the
superintendent may deem it expedient. The superintendent may promulgate
regulations establishing methods and procedures for facilitating and
verifying compliance with the requirements of this section and such
other regulations as necessary.
(h) The superintendent may issue a replacement for a currently
in-force license that has been lost or destroyed. Before the replacement
license shall be issued, there shall be on file in the office of the
superintendent a written application for the replacement license,
affirming under penalty of perjury that the original license has been
lost or destroyed, together with a fee of eight hundred dollars.
(i) No pharmacy benefit manager shall engage in any practice or action
that a health plan is prohibited from engaging in pursuant to this
chapter.
superintendent may issue a pharmacy benefit manager's license to any
person, firm, association or corporation who or that has complied with
the requirements of this article, including regulations promulgated by
the superintendent. The superintendent, in consultation with the
commissioner of health, shall establish, by regulation, minimum
standards for the issuance of a license to a pharmacy benefit manager.
(b) The minimum standards established under this subsection shall
contain both prerequisites for the issuance of a license and
requirements for maintenance of a license and shall address, without
limitation:
(1) conflicts of interest between pharmacy benefit managers and health
plans or insurers;
(2) deceptive practices in connection with the performance of pharmacy
benefit management services;
(3) anti-competitive practices in connection with the performance of
pharmacy benefit management services;
(4) unfair claims practices in connection with the performance of
pharmacy benefit management services;
(5) pricing models used by pharmacy benefit managers both for their
services and for the payment of services to the pharmacy benefit
manager;
(6) standards and practices used in the creation of pharmacy networks
and contracting with network pharmacies and other providers, including
promotion and use of independent and community pharmacies and patient
access and minimizing excessive concentration and vertical integration
of markets; and
(7) protection of consumers.
(c) For each business entity, the officer or officers and director or
directors named in the application shall be designated responsible for
the business entity's compliance with the insurance laws, rules and
regulations of this state.
(d)(1) Before a pharmacy benefit manager's license shall be issued or
renewed, the prospective licensee shall properly file in the office of
the superintendent an application therefor in such form or forms and
supplements thereto as the superintendent prescribes, and pay a fee of
eight thousand dollars for each year or fraction of a year in which a
license shall be valid.
(2) Every pharmacy benefit manager's license shall expire thirty-six
months after the date of issue. Every license issued pursuant to this
section may be renewed for the ensuing period of thirty-six months upon
the filing of an application in conformity with this subsection.
(e) If an application for a renewal license shall have been filed with
the superintendent at least two months before its expiration, then the
license sought to be renewed shall continue in full force and effect
either until the issuance by the superintendent of the renewal license
applied for or until five days after the superintendent shall have
refused to issue such renewal license and given notice of such refusal
to the applicant.
(f) The superintendent may refuse to issue a pharmacy benefit
manager's license if, in the superintendent's judgment, the applicant or
any member, principal, officer or director of the applicant, is not
trustworthy and competent to act as or in connection with a pharmacy
benefit manager, or that any of the foregoing has given cause for
revocation or suspension of such license, or has failed to comply with
any prerequisite for the issuance of such license.
(g) Licensees and applicants for a license under this section shall be
subject to examination by the superintendent as often as the
superintendent may deem it expedient. The superintendent may promulgate
regulations establishing methods and procedures for facilitating and
verifying compliance with the requirements of this section and such
other regulations as necessary.
(h) The superintendent may issue a replacement for a currently
in-force license that has been lost or destroyed. Before the replacement
license shall be issued, there shall be on file in the office of the
superintendent a written application for the replacement license,
affirming under penalty of perjury that the original license has been
lost or destroyed, together with a fee of eight hundred dollars.
(i) No pharmacy benefit manager shall engage in any practice or action
that a health plan is prohibited from engaging in pursuant to this
chapter.