Share this e-Alert:

Polsinelli - Insurance Polsinelli - Insurance
         

  

November 2016

  

Pharmacy Benefit Managers Face New Licensing Requirements

  

 
 

  

     

  

 
 

Third Party Administrators Professionals:

  

Steven L. Imber

913.234.7469

Email | Bio

  

Justin T. Liby

913.234.7427

Email | Bio

  

Jennifer Osborn Nix

913.234.7472

Email | Bio

  

  

To learn more about our Third Party Administrators practice, to contact one of our Third Party Administrators attorneys, or for more Third Party Administrators Intelligence, click here.

  

  


View Polsinelli documents on JD Supra  
LinkedIn Twitter Facebook Polsinelli Podcast

SUBSCRIBE

LinkedIn Twitter Facebook Inside Law Podcast Connect with us on LinkedIn. Connection with us on Twitter. Connect with us on Facebook. Connect with us on LinkedIn. Connection with us on Twitter. Connect with us on Facebook.

 

   

Two states recently enacted new pharmacy benefit manager licensing requirements that affect pharmacy benefit managers in Kentucky and New Mexico. It is important for Pharmacy Benefit Managers to ensure they are in compliance with these new laws.

The details of the actions are summarized below.

Kentucky SB 117

Kentucky Senate Bill 117 revised the definition of a "pharmacy benefit manager" (PBM) and "maximum allowable cost." It also clarifies PBM obligations, including an appeal process for certain parties and the maximum allowable cost to determine the drug product reimbursement. Further, Senate Bill 117 creates a new requirement for PBMs to obtain a license from the Kentucky Insurance Department by January 1, 2017. Per the Kentucky Insurance Department, as of January 1, 2017, an entity may not do business in Kentucky as a PBM until its PBM license has been issued. The Kentucky Insurance Department just recently published the PBM licensure application on its website.

New Mexico

The New Mexico Superintendent of Insurance recently issued Bulletin 2016-021, which supersedes Bulletin No. 2014-014.

According to the Superintendent, Bulletin 2016-21 was issued to advise any unlicensed PBM doing business in New Mexico that a PBM application must be submitted to the New Mexico Office of the Superintendent of Insurance by November 1, 2016, and that failure to comply with provisions of the New Mexico Pharmacy Benefits Manager Regulation Act may result in a monetary penalty of up to $10,000 per violation and cessation of business operations in New Mexico.

For More Information

Polsinelli's Insurance and Health Care teams include attorneys who were former in-house counsel for TPAs and PBMs, as well as attorneys who were formerly insurance regulators.

By leveraging its extensive experience representing TPAs and PBMs, the Polsinelli team helps clients avoid the learning curve and related cost implications that can be experienced by working with companies or attorneys less familiar with the regulatory and compliance needs of TPAs and PBMs. For additional information regarding this article, please contact one of the authors, a member of Polsinelli’s Third Party Administrators practice, or your Polsinelli attorney.

 
 

  

     

  

 

 

  

     

  

 
 

Atlanta  Boston  Chattanooga  Chicago  Dallas  Denver  Houston  Kansas City  Los Angeles  Nashville  New York
Overland Park  Phoenix  Raleigh  San Francisco  Silicon Valley  St. Joseph  St. Louis  Washington, D.C.  Wilmington
polsinelli.com

 

  

     

  

 
 

  

ABOUT POLSINELLI

real challenges. real answers.SM  
Polsinelli is an Am Law 100 firm with more than 800 attorneys in 20 offices, serving corporations, institutions, and entrepreneurs nationally. Ranked in the top five percent of law firms for client service*, the firm has risen more than 50 spots over the past five years in the Am Law 100 annual law firm ranking. Polsinelli attorneys provide practical legal counsel infused with business insight, and focus on health care, financial services, real estate, intellectual property, mid-market corporate, labor and employment, and business litigation. Polsinelli attorneys have depth of experience in 100 service areas and 70 industries. The firm can be found online at www.polsinelli.com. Polsinelli PC. In California, Polsinelli LLP.

* 2016 BTI Client Service A-Team Report

  

 
 

  

     

  

 
 

Polsinelli provides this material for informational purposes only. The material provided herein is general and is not intended to be legal advice. Polsinelli is very proud of the results we obtain for our clients, but you should know that past results do not guarantee future results; that every case is different and must be judged on its own merits; and that the choice of a lawyer is an important decision and should not be based solely upon advertisements.

Copyright © 2016 Polsinelli PC.

 
 

  

     

  

 
Connect with us on LinkedIn. Connection with us on Twitter. Connect with us on Facebook. Polsinelli Third Party Administrator (TPA) Licensing and Compliance Services Third Party Administrator (TPA) Licensing and Compliance Services