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Pharmacy Benefit Managers and Auditing Entities

Pharmacy Audit Integrity and Transparency Act

As a result of Act 169 of 2016, all pharmacy benefit managers and entities conducting pharmacy audits must register with the Pennsylvania Insurance Department.

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 pharmacy records for prescription or nonproprietary drugs dispensed by a pharmacy. 

List of Current Pharmacy Benefit Managers and Auditing Entities

Currently registered pharmacy benefit managers and auditing agencies can be found by visiting the Search for Registered Pharmacy Benefit Managers and Auditing Entities page.

How Do I register?

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

Pennsylvania Insurance Department
Company Licensing Division
345 Strawberry Square
Harrisburg, PA 17120

What is the term of registration?

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

How Do I Renew?

You may renew by downloading the PBM renewal form. Complete the form, noting any changes since the most recent registration, and mail it, along with a check for $35 made payable to the "Commonwealth of Pennsylvania" to:

Pennsylvania Insurance Department
Company Licensing Division
1345 Strawberry Square
Harrisburg, PA 17120

*NOTE: The department has engaged an outside vendor to allow renewal online with electronic payments. Online renewal is expected to be available in the future.

Questions?

If you have questions, don't hesitate to get in touch with the Insurance Department's company licensing department at ra-in-companylicense@pa.gov or (717) 787-2735.