NYDFS Pharmacy Benefits Registration

On May 24, NYDFS on pharmacy benefit manager licensure standards.

  • NYDFS proposed rules to establish Pharmacy benefits manager (PBM) requirements.
  • Amended NY INS 11-450 (benefits); added NY INS 11-453 (PBM assessments), NY INS 11-454 (filings and license requirements), and NY INS 11-455 (reporting and records).
  • Provided redline version of proposed amendments to NY INS 11-450 (benefits bureau).
  • PBM Assessments
  • Added new NY INS 11-453 (Regulation 223) to establish PBM assessment standards.
  • Defined assessment process for NYDFS operating expenses related to PBM regulation.
  • Assessment is equal to the total operating cost and is assessed for all registered PBMs.
  • Total operating costs are divided pro rata among registrants and licensees based on their share of the aggregate number of claims processed for pharmacies in the State.
  • Licenses/registrations may be suspended, revoked, or terminated for noncompliance.
  • Established a special assessment process in the event the Superintendent determines that expenses associated with a specific exam are best allocated solely to specific PBM.
  • PBM Licensing
  • Created NY INS 11-454 (Regulation 224) on PBM licensure application requirements.
  • Set licensing process and defined required application information; filed electronically.
  • Must pay the NYDFS Superintendent a non-refundable license application fee of $24k.
  • Required licensees to be compliant with cybersecurity requirements in NY LEG 23-500.
  • Reporting and Record Retention
  • Also created NY INS 11-455 (Regulation 225) on PBM reporting and record retention.
  • Records and indices must be maintained in durable medium; defined required records.
  • Disclosure requirements defined; set forth annual reporting requirements to PBMs.
  • Pharmacy Benefit Definitions
  • Proposed amendment to NY INS 11-450 (Regulation 219) amended definition section.
  • To include additional definitions for certain terms and words used in the new rules.
  • Consultation
  • Comments on amended and proposed regulations are due in 60 days on Jul. 24, 2023.

Regulators NYDFS
Entity Types Ins
Reference NY SR Vol. 45 No. 21, RF DFS-21-23-00002-P, 5/24/2023; Citation: NY INS 11-450; NY LEG 23-500;
Functions Claims/Accelerated Benefits; Compliance; Cyber; Financial; Legal; Operations; Record Retention; Registration/Licensing; Reporting; Technology
Countries United States of America
Category State Regulator
State New York
Products Insurance; Insurance-Health
Regions Am
Rule Type Proposed
Rule Date 5/24/2023
Effective Date 7/24/2023
Rule Id 173649
Linked to N/A
Reg. Last Update 5/24/2023
Report Section US Insurance

Last substantive update on 05/25/2023