§ 2906 — Licensing of a pharmacy benefit manager

§ 2906. Licensing of a pharmacy benefit manager. (a) The\nsuperintendent may issue a pharmacy benefit manager's license to any\nperson, firm, association or corporation who or that has complied with\nthe requirements of this article, including regulations promulgated by\nthe superintendent. The superintendent, in consultation with the\ncommissioner of health, shall establish, by regulation, minimum\nstandards for the issuance of a license to a pharmacy benefit manager.\n (b) The minimum standards established under this subsection shall\ncontain both prerequisites for the issuance of a license and\nrequirements for maintenance of a license and shall address, without\nlimitation:\n (1) conflicts of interest between pharmacy benefit managers and health\nplans or insurers;\n (2) deceptive practices in connection with the performance of pharmacy\nbenefit management services;\n (3) anti-competitive practices in connection with the performance of\npharmacy benefit management services;\n (4) unfair claims practices in connection with the performance of\npharmacy benefit management services;\n (5) pricing models used by pharmacy benefit managers both for their\nservices and for the payment of services to the pharmacy benefit\nmanager;\n (6) standards and practices used in the creation of pharmacy networks\nand contracting with network pharmacies and other providers, including\npromotion and use of independent and community pharmacies and patient\naccess and minimizing excessive concentration and vertical integration\nof markets; and\n (7) protection of consumers.\n (c) For each business entity, the officer or officers and director or\ndirectors named in the application shall be designated responsible for\nthe business entity's compliance with the insurance laws, rules and\nregulations of this state.\n (d)(1) Before a pharmacy benefit manager's license shall be issued or\nrenewed, the prospective licensee shall properly file in the office of\nthe superintendent an application therefor in such form or forms and\nsupplements thereto as the superintendent prescribes, and pay a fee of\neight thousand dollars for each year or fraction of a year in which a\nlicense shall be valid.\n (2) Every pharmacy benefit manager's license shall expire thirty-six\nmonths after the date of issue. Every license issued pursuant to this\nsection may be renewed for the ensuing period of thirty-six months upon\nthe filing of an application in conformity with this subsection.\n (e) If an application for a renewal license shall have been filed with\nthe superintendent at least two months before its expiration, then the\nlicense sought to be renewed shall continue in full force and effect\neither until the issuance by the superintendent of the renewal license\napplied for or until five days after the superintendent shall have\nrefused to issue such renewal license and given notice of such refusal\nto the applicant.\n (f) The superintendent may refuse to issue a pharmacy benefit\nmanager's license if, in the superintendent's judgment, the applicant or\nany member, principal, officer or director of the applicant, is not\ntrustworthy and competent to act as or in connection with a pharmacy\nbenefit manager, or that any of the foregoing has given cause for\nrevocation or suspension of such license, or has failed to comply with\nany prerequisite for the issuance of such license.\n (g) Licensees and applicants for a license under this section shall be\nsubject to examination by the superintendent as often as the\nsuperintendent may deem it expedient. The superintendent may promulgate\nregulations establishing methods and procedures for facilitating and\nverifying compliance with the requirements of this section and such\nother regulations as necessary.\n (h) The superintendent may issue a replacement for a currently\nin-force license that has been lost or destroyed. Before the replacement\nlicense shall be issued, there shall be on file in the office of the\nsuperintendent a written application for the replacement license,\naffirming under penalty of perjury that the original license has been\nlost or destroyed, together with a fee of eight hundred dollars.\n (i) No pharmacy benefit manager shall engage in any practice or action\nthat a health plan is prohibited from engaging in pursuant to this\nchapter.\n