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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, 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
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?

By mail:

You may renew by downloading the renewal form found here. Complete the form, noting any changes since the most recent registration. Mail 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, please contact the Insurance Department at ra-in-companylicense@pa.gov or (717) 787-2735.