PHARMACY BENEFIT MANAGERS AND AUDITING ENTITIES
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,
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
IS THE TERM OF REGISTRATION?
must be renewed every two years from the date of issuance.
have questions, please contact the Insurance Department at firstname.lastname@example.org or