Skip Navigation LinksPennsylvania Insurance Department > Licensees > Pharmacy Benefit Managers

pharmacy benefit managers and auditing entitites

PHARMACY AUDIT INTEGRITY AND TRANSPARENCY ACT

On November 21, 2016, Governor Tom Wolf signed into law Act 169 of 2016, which establishes procedures for pharmacy audits and requires pharmacy benefit managers and entities conducting pharmacy audits to register with the Pennsylvania Insurance Department.  All pharmacy benefit managers and auditing entities doing business in Pennsylvania must register by February 19, 2017

WHAT IS A PHARMACY BENEFIT MANAGER?

A pharmacy benefit manager (PBM) administers prescription drug plans for health insurance plans.  Pharmacy benefits management includes negotiating with drug manufacturers for contracted prices, operating a mail-order pharmacy, processing claims, managing retail pharmacy networks, managing a clinical formulary, and setting pharmacy reimbursement pricing.

WHAT IS AN AUDITING ENTITY?

An auditing entity is a person or company that performs on-site audits of any records of a pharmacy for prescription or nonproprietary drugs dispensed by a pharmacy. 

HOW DO I REGISTER?

Complete the registration form and mail with a check for $35.00 made payable to the “Commonwealth of Pennsylvania” to:

Pennsylvania Insurance Department

Company Licensing Division

1345 Strawberry Square

Harrisburg, PA 17120

 

WHAT IS THE TERM OF REGISTRATION?

Registration must be renewed every two years from the date of issuance. 

QUESTIONS?

If you have questions, please contact the Insurance Department at ra-in-companylicense@pa.gov or (717) 787-2735.