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.
- Comments on amended and proposed regulations are due in 60 days on Jul. 24, 2023.
||NY SR Vol. 45 No. 21, RF DFS-21-23-00002-P, 5/24/2023; Citation: NY INS 11-450; NY LEG 23-500;
||Claims/Accelerated Benefits; Compliance; Cyber; Financial; Legal; Operations; Record Retention; Registration/Licensing; Reporting; Technology
||United States of America
|Reg. Last Update
Last substantive update on 05/25/2023