Is Your State Enforcing PBM Regulations?

NO?

You must file complaints with
your state department of insurance!

THIS IS HOW YOU DO IT.

Virtually every single state has passed some form of pharmacy benefit manager regulations over the last several years. Although there have been great strides forward with comprehensive state PBM regulations and court victories, this is all irrelevant if the state departments of insurance are not enforcing these laws.

You must be proactive and hold your insurance regulator's feet to the fire. You do that by filing complaints when the insurers/PBMs are NOT following the law in your respective state. It happens all the time (shocking, we know, PBMs not following the law). The more legitimate, factual-based complaints a department of insurance receives, the more likely it is to investigate and ENFORCE the law.

How to use this resource to file a complaint:

1) Go to the link for your state below. It includes information on the state's PBM laws and a link to the state's department of insurance complaint form.

2) Check NCPA's state law tracker (includes state-by-state PBM laws).

  • What are the laws in your state(s)?

  • Are insurers/PBMs in compliance?

  • If the answer is “no” then move on to step three.

3) Find the link to your state department of insurance's complaint form. NCPA has provided a link to all state complaint forms.

  • Not all states will have a specific PBM complaint form so it's OK to use the general consumer health insurance complaint form.

4) Fill out the complaint form (most state have online and hard copy options).

  • Include a clear and concise description of the insurer/PBM's non-compliance (i.e., state law prohibits clawbacks and PBMs continue to claw back funds after the point of sale).

  • Cite the specific state statute (which is included on the state law tracker).

  • Include records/claim/other evidence of the PBMs' violations.

  • Include all other information required by your respective state's complaint form.

Remember: When it comes to filing complaints, quantity and quality are equally important. The number of complaints matters as does the quality of the complaint, meaning it's important to have evidence/supporting documents included with your complaint.

Should you have any questions about filing, please feel to reach out to Anne Cassity or Joel Kurzman. Also, your state pharmacy association is always a great resource for these issues.

Note — state departments of insurance have regulatory authority over commercial insurers/claims. Any complaints against PBMs operating in the state Medicaid managed care program will generally have to be filed with the state Medicaid/health agency.

  • Alabama

    PBM licensure/registration requirement

    Licensure (Ala. Code 27-45A-4)

    Fair pharmacy audit procedures

    Ala. Code 34-23-180 through -187

    Any Willing Pharmacy

    Ala. Code 27-45-3 and 27-45A-10

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    Ala. Code 27-45A-10

    Complaint Form

  • Alaska

    PBM licensure/registration requirement

    Registration (Alaska Stat. 21.27.901)

    Fair pharmacy audit procedures

    Alaska Stat. 21.27.910 through .940

    Requirement for reimbursement appeal procedure

    Alaska Stat. 21.27.945 through .950

    Complaint Form

  • Arizona

    PBM licensure/registration requirement

    Certification - ARS 20-3333 and 20-3334 (Note: effective after December 31, 2024)

    Prohibition against adjudication fees

    ARS 20-3332

    Fair pharmacy audit procedures

    ARS 20-3321 through -3324

    Prohibition against anti-mandatory mail-order

    ARS 20-1410

    Requirement for reimbursement appeal procedure

    Ariz. Rev. Stat. 20-3331

    Provider Grievance Tool 

  • Arkansas

    PBM licensure/registration requirement

    Licensure (Ark. Code 23-92-504)

    Prohibition against retroactive claim adjustments

    Ark. Code 23-92-506 (c)(1)-(3)

    Prohibition against adjudication fees

    Ark. Code 23-92-506 (b)(2)

    Fair pharmacy audit procedures

    Ark. Code 17-92-1201

    Prohibition against anti-mandatory mail-order

    Ark. Code 23-92-603

    Any Willing Pharmacy

    Ark. Code 23-99-804

    Requirement for reimbursement appeal procedure

    Ark. Code 17-92-507

    Requirements that reimbursement appeals apply to non-MAC reimbursements

    Ark. Code 17-92-507

    Limits on accreditation requirements stricter than state standards

    Ark. Code 23-92-506(b)(3)

    Protections from below-cost reimbursements

    Ark. Code 17-92-507

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    Ark. Code 23-92-506(b)(4)(A)

    Complaint Form

  • California

    PBM licensure/registration requirement

    Registration (Cal. HSC 1385.004)

    Fair pharmacy audit procedures

    Cal. BPC 4431 through 4438

    Prohibition against anti-mandatory mail-order

    Cal. HSC 1367.42

    Requirement for reimbursement appeal procedure

    Cal. BPC 4440

    Complaint Form

  • Colorado

    PBM licensure/registration requirement

    Registration (CRS 10-16-122.1(2.5))

    Prohibition against retroactive claim adjustments 

    C.R.S. 10-16-122.3 (2)(a)

    Prohibition against adjudication fees

    CRS 10-16-122.1

    Fair pharmacy audit procedures

    C.R.S. 10-16-122.5

    Anti-mandatory mail order

    CRS 10-16-122.1

    Any Willing Pharmacy

    C.R.S. 10-16-122

    Requirement for reimbursement appeal procedure

    C.R.S. 25-37-103.5

    Prohibitions against arbitrary accreditation requirements

    CRS 10-16-122.1

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    C.R.S. 10-16-122.3 (1)(a)

    Complaint Form

  • Connecticut

    PBM licensure/registration requirement

    Registration (Ct. Stat. 38a-479bbb)

    Prohibition against retroactive claim adjustments

    Ct. Stat. 38a-477cc

    Fair pharmacy audit procedures

    Ct. Stat. 38a-479iii

    Prohibition against anti-mandatory mail-order

    Ct. Stat. 38a-510 and 38a-544

    Complaint Form

  • Delaware

    PBM licensure/registration requirement

    Registration (Del. Code Tit. 18 Ch. 33A Subch. V)

    Fair pharmacy audit procedures

    Del. Code Tit. 18 Ch. 33A Subch. I

    Prohibition against anti-mandatory mail-order

    Del. Code Tit. 18 Sec. 7303

    Any Willing Pharmacy

    Del. Code Tit. 18 Sec. 7303

    Requirement for reimbursement appeal procedure

    Del. Code Tit. 18 Ch. 33A Subch. II

    Complaint Form

  • Florida

    PBM licensure/registration requirement

    Certification Fla. Stat. 626.8805

    Prohibition against retroactive claims adjustments

    Fla. Stat. 626.8825

    Prohibition against adjudication fees

    Fla. Stat. 626.8825

    Fair pharmacy audit procedures

    Fla. Stat. 465.1885

    Anti-mandatory mail order

    Fla. Stat. 626.8825

    Requirement for reimbursement appeal procedure

    Fla. Stat. 626.8825

    Prohibition against arbitrary accreditation requirements

    Fla. Stat. 626.8825

    Prohibition of patient steering

    Fla. Stat. 626.8825

     

     

    Complaints on issues regarding PBMs can be made to the Department of Financial Services (DFS), Division of Consumer Services by emailing [email protected]. For more information, please visit the DFS Consumer Services website here.  

    Complaints on PBM issues regarding Florida Medicaid providers should be submitted to the Agency for Health Care Administration (AHCA). More information is available on AHCA's website here.

     

  • Georgia

    PBM licensure/registration requirement

    Licensure (OCGA 33-64-2)

    Prohibition against retroactive claim adjustments

    OCGA 33-64-11 (a)(5)

    Prohibition against adjudication fees

    OCGA 33-64-11 (a)(4)

    Fair pharmacy audit procedures

    OCGA 26-4-118

    Prohibition against anti-mandatory mail-order

    OCGA 33-64-10

    Any Willing Pharmacy

    OCGA 33-30-4.3

    Requirement for reimbursement appeal procedure

    OCGA 33-64-9

    Complaint Form

  • Hawaii

    PBM licensure/registration requirement

    Registration (HRS 431S-3)

    Prohibition against anti-mandatory mail-order

    HRS 431R-3

    Any Willing Pharmacy

    HRS 431R-2

    Requirement for reimbursement appeal procedure

    HRS 328-106

    Complaint Form

  • Idaho

    PBM licensure/registration requirement

    Registration (Id. Stat. 41-349 (b)(2))

    Prohibition against retroactive claim adjustments

    Id. Stat. 41-349 (5)

    Fair pharmacy audit procedures

    Id. Stat. 41-6601 thru 6605

    Any Willing Pharmacy

    Id. Stat. 41-3927

    Requirement for reimbursement appeal procedure

    Id. Stat. 41-349 (4) 

    Complaint Form

  • Illinois

    PBM licensure/registration requirement

    Registration (215 ILCS 5/513b2)

    Any Willing Pharmacy

    215 ILCS 134/72

    Requirement for reimbursement appeal procedure

    215 ILCS 5/513b1

    Complaint Form

  • Indiana

    PBM licensure/registration requirement

    Licensure (IC 27-1-24.5-18)

    Prohibition against retroactive claim adjustments

    IC 27-1-24.5-19 (b)(3) and (4)

    Fair pharmacy audit procedures

    IC 25-26-22.1-22.11

    Any Willing Pharmacy

    IC 27-8-11-3(c)

    Requirement for reimbursement appeal procedure

    IC 27-1-24.5-22

    Requirements that reimbursement appeals apply to non-MAC reimbursements

    IC 27-1-24.5-19 (b)(4)

    Limits on accreditation requirements stricter than state standards

    IC 27-1-24.5-19 (b)(1)

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    IC 27-1-24.5-19 (b)(5)

    Complaint Form

  • Iowa

    PBM licensure/registration requirement

    Certificate (IC 510B.2)

    Fair pharmacy audit procedures

    IC 510B.3 and Iowa Admin. Code r. 191-59.4

    Requirement for reimbursement appeal procedure

    IC 510B.8 and Iowa Admin. Code r. 191-59.4 (4) and (5)

    Complaint Form

  • Kansas

    PBM licensure/registration requirement

    Registration (KSA 40-3823)

    Fair pharmacy audit procedures

    KSA 65-16,121 through 16,126

    Prohibition against anti-mandatory mail-order

    KSA 40-2,153

    Requirement for reimbursement appeal procedure

    KSA 40-3830

    Complaint Form

  • Kentucky

    PBM licensure/registration requirement

    KRS 304.9-053

    Fair pharmacy audit procedures

    KRS 304.17A-741

    Prohibition against anti-mandatory mail-order (only applies to state employee plan)

    KRS 18A.225

    Any Willing Pharmacy

    KRS 304.17A-270

    Requirement for reimbursement appeal procedure

    KRS 304.17A-162

    Complaint Form

  • Louisiana

    PBM licensure/registration requirement

    Licensure LRS 22:1657(A)

    Prohibition against retroactive claim adjustments

    LRS 40:2870(A)(7)

    Prohibition against adjudication fees

    LRS 22:1860.2

    Fair pharmacy audit procedures

    LRS 22:1856.1

    Prohibition against anti-mandatory mail-order

    LRS 40:2870 (5)(a) and (6)(a)

    Any Willing Pharmacy

    LRS 22:1964 (15)(a)

    Requirement for reimbursement appeal procedure

    LRS 22:1865

    Requirements that reimbursement appeals apply to non-MAC reimbursements (defines MAC as ANY term that a pharmacy benefit manager or a healthcare insurer may use to establish reimbursement rates for generic and multi-source brand drugs

    LRS 22:1863(2) and LRS 22:1865

    Limits on accreditation requirements stricter than state standards

    LRS 22:1651 (J)

    Protections from below-cost reimbursements

    LRS 22:1860.3 (B)

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    LRS 22:1860.3 (A)

    Complaint Form

  • Maine

    PBM licensure/registration requirement

    Licensure (MRS 24-A, 4348)

    Prohibition against retroactive claim adjustments

    MRS 24-A, 4350 (8)(D)

    Prohibition against adjudication fees

    MRS 24-A, 4317 (2)(J)

    Fair pharmacy audit procedures

    MRS 24-A, 4317 (10)

    Any Willing Pharmacy

    MRS 24-A, 4317 (1)

    Requirement for reimbursement appeal procedure

    MRS 24-A, 4350

    Requirement for reimbursement appeal procedure

    MRS 24-A, 4350

    Complaint Form

  • Maryland

    PBM licensure/registration requirement

    Registration (Md. Code, Ins. 15-1604)

    Prohibition against retroactive claim adjustments

    Md. Code, Ins. 15-1631

    Prohibition against adjudication fees

    Md. Code, Ins. 15-1628.3

    Fair pharmacy audit procedures

    Md. Code, Ins. 15-1629

    Prohibition against anti-mandatory mail-order

    Md. Code, Ins. 15-1611.1

    Requirement for reimbursement appeal procedure

    Md. Code, Ins. 15-1628.1 (f)

    Requirements that reimbursement appeals apply to non-MAC reimbursements

    Md. Code, Ins. 15-1628.2

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    Md. Code, Ins. 15-1612

    Complaint Form

  • Massachusetts

    PBM licensure/registration requirement

    Licensure (Mass. Gen. Law Part I, Tit. XXII, Ch. 1760, Sec. 21)

    Fair pharmacy audit procedures

    Mass. Gen. Law 175, Sec. 226

    Any Willing Pharmacy

    Mass. Gen. Law 176D, 3B

    Complaint Form

  • Michigan

    *Note: the provisions of Michigan HB 4348 (2022) become effective on January 1, 2024.

    PBM licensure/registration requirement

    Licensure (HB 4348 (2022), Sec. 11

    Prohibition against retroactive claim adjustments

    HB 4348 (2022), Sec. 15

    Prohibition against adjudication fees

    HB 4348 (2022), Sec. 15

    Fair pharmacy audit procedures

    HB 4348 (2022), Sec. 28

    Requirement for reimbursement appeal procedure

    HB 4348 (2022), Sec. 27

     

    From the Department of Insurance and Financial Services' PBM Web Page.

    We encourage consumers and pharmacies to first attempt to resolve their disputes directly with the PBM. If a resolution cannot be reached, our office can help try to resolve your dispute. Our Call Center Specialists are available to help you Monday through Friday, from 8 a.m. to 5 p.m. at 877-999-6442.

    Complaints can be submitted in the following ways:

    • Online: www.michigan.gov/DIFSComplaints
    • Email: [email protected]
    • Fax: 517-284-8837
    • Mail: Department of Insurance and Financial Services
      Office of Consumer Services
      PO Box 30220
      Lansing, MI 48909
    • If you are unable to file a complaint online, you may obtain a copy of the complaint form and mail, email, or fax it to DIFS.
  • Minnesota

    PBM licensure/registration requirement

    Licensure (Minn. Stat. 62W.03)

    Prohibition against retroactive claim adjustments

    Minn. Stat. 62W.13

    Fair pharmacy audit procedures

    Minn. Stat. 62W.09

    Prohibition against anti-mandatory mail-order

    Minn. Stat. 62W.07 (b) and (c)

    Requirement for reimbursement appeal procedure

    Minn. Stat. 62W.08

    Limits on accreditation requirements stricter than state standards

    Minn. Stat. 62W.05, Subd. 3

    Complaint Form

  • Mississippi

    PBM licensure/registration requirement

    Licensure (Miss. Code 73-21-157)

    Prohibition against retroactive claim adjustments

    Miss. Code 73-21-155

    Fair pharmacy audit procedures

    Miss. Code 73-21-183

    Prohibition against anti-mandatory mail-order

    Miss. Code 83-9-6

    Any Willing Pharmacy

    Miss. Code 83-9-6

    Requirement for reimbursement appeal procedure

    Miss. Code 73-21-156

    Limits on accreditation requirements stricter than state standards

    Miss. Code 73-21-157

    Complaint Form

  • Missouri

    PBM licensure/registration requirement

    Licensure (Mo. Rev. Stat. 376.393)

    Prohibition against adjudication fees

    Mo. Rev. Stat. 376.387 Sec. 4

    Fair pharmacy audit procedures

    Mo. Rev. Stat. 338.600

    Requirement for reimbursement appeal procedure

    Mo. Rev. Stat. 376.388

    Complaint Form

  • Montana

    PBM licensure/registration requirement

    Licensure (Ch. 501 (2021), Sec. 3)

    Prohibition against adjudication fees

    MCA 33-22-175

    Fair pharmacy audit procedures

    MCA 22-2

    Prohibition against anti-mandatory mail-order

    Mont. Code 2-18-704 and 39-71-727

    Requirement for reimbursement appeal procedure

    MCA 33-22-173

    Limits on accreditation requirements stricter than state standards

    MCA 33-22-177

    Protections from below-cost reimbursements

    MCA 33-22-174

    Complaint Form

  • Nebraska

    Prohibition against anti-mandatory mail-order

    NRS 44-513.2

    Complaint Form

  • Nevada

    No PBM regulations at this time.

  • New Hampshire

    PBM licensure/registration requirement

    Registration (N.H. Rev. Stat. 402-N:2)

    Prohibition against retroactive claim adjustments

    N.H. Rev. Stat. 402-N:4

    Fair pharmacy audit procedures

    N.H. Rev. Stat. 318:62

    Prohibition against anti-mandatory mail-order

    N.H. Rev. Stat. 420-J:7-b

    Any Willing Pharmacy

    N.H. Rev. Stat. 420-B:12

    Requirement for reimbursement appeal procedure

    N.H. Rev. Stat 402-N:3

    Limits on accreditation requirements stricter than state standards

    N.H. Rev. Stat 402-N:3

    Complaint Form

  • New Jersey

    PBM licensure/registration requirement

    Licensure - 2023 A 536/2841 (effective January 1, 2025)

    Prohibition against retroactive claim adjustments

    N.J. Stat. 17B:27F-7

    Any Willing Pharmacy

    N.J. Stat. 17:48-6j

    Prohibition against anti-mandatory mail-order

    N.J. Stat. 17:48-6j

    Requirement for reimbursement appeal procedure

    N.J. Stat. 17B:27F-4

    Requirements that reimbursement appeals apply to non-MAC reimbursements

    N.J. Stat. 17B:27F-4

    Complaint Form

  • New Mexico

    PBM licensure/registration requirement

    Licensure (NMSA 59A-61-3)

    Prohibition against retroactive claim adjustments

    NMSA 59A-61-6

    Prohibition against adjudication fees

    NMSA 59A-61-7

    Fair pharmacy audit procedures

    NMSA 61-11-18.2

    Requirement for reimbursement appeal procedure

    NMSA 59A-61-4

    Limits on accreditation requirements stricter than state standards

    NMSA 59A-61-5

    Complaint Form

  • New York

    Fair pharmacy audit procedures

    NY Pub. Health Law 280-c

    Prohibition against anti-mandatory mail-order

    NY Ins. Law 3216

    Requirement for reimbursement appeal procedure

    NY Pub. Health Law 280-a

    Requirement for reimbursement appeal procedure

    NY Pub. Health Law 280-a

    Complaint Form

  • North Carolina

    Prohibition against adjudication fees

    NC Gen. Stat. 58-56A-4

    Fair pharmacy audit procedures

    NC Gen. Stat. 90-85.50 through 90-85.52

    Prohibition against anti-mandatory mail-order

    N.C. Gen. Stat. 58-51-37

    Any Willing Pharmacy

    NC Gen. Stat. 58-51-37

    Complaint Form

  • North Dakota

    PBM licensure/registration requirement

    Licensure (ND Code 26.1-27.1-2)

    Prohibition against adjudication fees

    ND Code 19-02.1-16.1 and 19-02.1-16.5

    Fair pharmacy audit procedures

    ND Code 19-03.6-02

    Prohibition against anti-mandatory mail-order

    ND Cent. Code 19-02.1-16.2

    Any Willing Pharmacy

    ND Code 26.1-27.1-4

    Requirement for reimbursement appeal procedure

    ND 19-02.1-14.2

    Limits on accreditation requirements stricter than state standards

    ND Code 19-02.1-16.1

    Complaint Form

  • Ohio

    Prohibition against retroactive claim adjustments

    ORC 3959.20

    Prohibition against adjudication fees

    ORC 3959.20

    Fair pharmacy audit procedures

    ORC 3901.81 through 3901.815

    Requirement for reimbursement appeal procedure

    ORC 3959.111

    Complaint Form

  • Oklahoma

    PBM licensure/registration requirement

    Licensure (Okla. Stat. 59-358)

    Prohibition against retroactive claim adjustments

    Okla. Stat. 36-6962

    Prohibition against adjudication fees

    Okla. Stat. 36-6962

    Fair pharmacy audit procedures

    Okla. Stat. 59-356

    Prohibition against anti-mandatory mail-order

    Okla. Stat. 36-6963

    Any Willing Pharmacy

    Okla. Stat. 36-6962

    Requirement for reimbursement appeal procedure

    Okla. Stat. 59-360

    Limits on accreditation requirements stricter than state standards

    Okla. Stat. 59-360

    Protections from below-cost reimbursements

    Okla. Stat. 59-360

    Complaint Form

  • Oregon

    PBM licensure/registration requirement

    Registration (ORS 735.532)

    Prohibition against retroactive claim adjustments

    ORS 734.534

    Fair pharmacy audit procedures

    ORS 735.540 through 735.552

    Prohibition against anti-mandatory mail-order

    ORS 735.536

    Requirement for reimbursement appeal procedure

    ORS 735.534

    Complaint Form (MAC)

    Complaint Form (Other PBM Complaints)

  • Pennsylvania

    PBM licensure/registration requirement

    Registration (40 P.S. 4521)

    Fair pharmacy audit procedures

    40 P.S. 4511

    Prohibition against anti-mandatory mail-order

    40 P.S. 764l

    Requirement for reimbursement appeal procedure

    40 P.S. 4533

    Complains be submitted on the Consumer Services webpage.

  • Rhode Island

    PBM licensure/registration requirement

    Certification (R.I. Gen. Laws 27-20.7-12)

    Fair pharmacy audit procedures

    R.I. Gen. Laws 5-19.1-35

    Any Willing Pharmacy

    R.I. Gen. Laws 27-29.1-5

    Requirement for reimbursement appeal procedure

    R.I. Gen. Laws 27-19-26.2

    Complaint Form

  • South Carolina

    PBM licensure/registration requirement

    Licensure (S.C. Laws 38-71-2210)

    Prohibition against retroactive claim adjustments

    S.C. Laws 38-71-2230

    Prohibition against adjudication fees

    S.C. Laws 38-71-2150 and 38-71-2230

    Fair pharmacy audit procedures

    S.C. Laws 38-71-1810 through -1830

    Prohibition against anti-mandatory mail-order

    S.C. Laws 38-71-2230

    Any Willing Pharmacy

    S.C. Laws 38-71-147

    Requirement for reimbursement appeal procedure

    S.C. Laws 38-71-2140 and 38-71-2240

    Prohibitions against arbitrary accreditation requirements

    S.C. Laws 38-71-2245

    Prohibition of patient steering

    S.C. Laws 38-71-2230

    Complaint Form

  • South Dakota

    PBM licensure/registration requirement

    Licensure S.D. Laws 58-29E-2

    Prohibition against retroactive claim adjustments

    S.D. Laws 58-29E-13

    Prohibition against adjudication fees

    S.D. Laws 58-29E-16

    Fair pharmacy audit procedures

    S.D. Laws 58-29F

    Prohibition against anti-mandatory mail-order

    S.D. Laws 58-18-37

    Any Willing Pharmacy

    S.D. Laws 58-18-37

    Not less reimbursement than PBM-owned pharmacies

    S.D. Laws 58-29E-19

     

    Complaint Form

  • Tennessee

    PBM licensure/registration requirement

    Licensure (Tenn. Laws 56-7-3113)

    Prohibition against adjudication fees

    Tenn. Laws 56-7-3115

    Fair pharmacy audit procedures

    Tenn. Laws 56-7-3103

    Prohibition against anti-mandatory mail-order

    Tenn. Laws 56-7-117

    Any Willing Pharmacy

    Tenn. Laws 56-7-2359

    Requirement for reimbursement appeal procedure

    Tenn. Laws 56-7-3108

    Requirement for reimbursement appeal procedure

    Tenn. Laws 56-7-3118

    Complaint Form

  • Texas

    Prohibition against retroactive claim adjustments

    Tex. Ins. Code 1369.553

    Prohibition against adjudication fees

    Tex. Ins. Code 1369.402

    Fair pharmacy audit procedures

    Tex. Ins. Code 1369.254 through .266

    Prohibition against anti-mandatory mail-order

    Tex. Ins. Code 1560.003

    Any Willing Pharmacy

    **Tex. Ins. Code 21.52B

    Requirement for reimbursement appeal procedure

    Tex. Ins. Code 1369.357

    Limits on accreditation requirements stricter than state standards

    Tex. Ins. Code 1369.558

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    Tex. Ins. Code 1369.554

    Complaint Form

  • Utah

    PBM licensure/registration requirement

    Licensure (Ut. Code 31A-46-201)

    Prohibition against retroactive claim adjustments

    Ut. Code 31A-46-304

    Fair pharmacy audit procedures

    Ut. Code 58-17b-622

    Requirement for reimbursement appeal procedure

    Ut. Code 31A-46-303

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    Ut. Code 31A-46-305

    Complaint Form

  • Vermont

    PBM licensure/registration requirement

    Registration (18 VSA 9421)

    Fair pharmacy audit procedures

    18 VSA 3802

    Prohibition against anti-mandatory mail-order

    8 VSA 4089j

    Requirement for reimbursement appeal procedure

    18 VSA 9473

    Complaint Form

  • Virginia

    PBM licensure/registration requirement

    Licensure (Va. Code 38.2-3466)

    Prohibition against adjudication fees

    Va. Code 38.2-3467

    Fair pharmacy audit procedures

    Va. Code 38.2-3407.15:1

    Any Willing Pharmacy

    Va. Code 38.2-4312.1

    Requirement for reimbursement appeal procedure

    Va. Code 38.2-3407.15:3

    Limits on accreditation requirements stricter than state standards

    Va. Code 38.2-3467

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    Va. Code 38.2-3467

    Complaint Form

  • Washington

    PBM licensure/registration requirement

    Registration (RCW 19.340.030)

    Fair pharmacy audit procedures

    RCW 19.340.040

    Requirement for reimbursement appeal procedure

    RCW 19.340.100

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    RCW 19.240.100

    Complaint Form

  • West Virginia

    PBM licensure/registration requirement

    Licensure (WV Code 33-51-8)

    Prohibition against adjudication fees

    WV Code 33-51-9

    Fair pharmacy audit procedures

    WV Code 33-51-4

    Prohibition against anti-mandatory mail-order

    WV Code 33-51-8

    Any Willing Pharmacy

    WV Code 33-51-11

    Prohibitions against PBMs reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies

    WV Code 33-51-9

    Complaint Form

  • Wisconsin

    PBM licensure/registration requirement

    Licensure (Wis. Stat. 632.865)

    Prohibition against retroactive claim adjustments

    Wis. Stat. 632.865

    Fair pharmacy audit procedures

    Wis. Stat. 632.865

    Prohibition against anti-mandatory mail-order

    Wis. Stat. 632.86

    Any Willing Pharmacy

    Wis. Stat. 632.86

    Requirement for reimbursement appeal procedure

    Wis. Stat. 632.865

    Limits on accreditation requirements stricter than state standards

    Wis. Stat. 632.865

    Complaint Form

  • Wyoming

    PBM licensure/registration requirement

    Licensure (Wyo. Stat. 26-52-101)

    Fair pharmacy audit procedures

    Wyo. Stat. 26-52-103

    Any Willing Pharmacy

    Wyo. Stat. 26-22-503

    Requirement for reimbursement appeal procedure

    Wyo. Stat. 26-52-104

    Complaint Form