2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2906 - Licensing of a Pharmacy Benefit Manager.

§   2906.   Licensing   of   a   pharmacy  benefit  manager.  (a)  The
superintendent may issue a pharmacy benefit  manager's  license  to  any
person,  firm,  association or corporation who or that has complied with
the requirements of this article, including regulations  promulgated  by
the   superintendent.  The  superintendent,  in  consultation  with  the
commissioner  of  health,  shall  establish,  by   regulation,   minimum
standards for the issuance of a license to a pharmacy benefit manager.
(b)  The  minimum  standards  established  under this subsection shall
contain  both  prerequisites  for  the  issuance  of   a   license   and
requirements  for  maintenance  of  a license and shall address, without
limitation:
(1) conflicts of interest between pharmacy benefit managers and health
plans or insurers;
(2) deceptive practices in connection with the performance of pharmacy
benefit management services;
(3) anti-competitive practices in connection with the  performance  of
pharmacy benefit management services;
(4)  unfair  claims  practices  in  connection with the performance of
pharmacy benefit management services;
(5) pricing models used by pharmacy benefit managers  both  for  their
services  and  for  the  payment  of  services  to  the pharmacy benefit
manager;
(6) standards and practices used in the creation of pharmacy  networks
and  contracting  with network pharmacies and other providers, including
promotion and use of independent and community  pharmacies  and  patient
access  and  minimizing excessive concentration and vertical integration
of markets; and
(7) protection of consumers.
(c) For each business entity, the officer or officers and director  or
directors  named  in the application shall be designated responsible for
the business entity's compliance with  the  insurance  laws,  rules  and
regulations of this state.
(d)(1)  Before a pharmacy benefit manager's license shall be issued or
renewed, the prospective licensee shall properly file in the  office  of
the  superintendent  an  application  therefor in such form or forms and
supplements thereto as the superintendent prescribes, and pay a  fee  of
eight  thousand  dollars  for each year or fraction of a year in which a
license shall be valid.
(2) Every pharmacy benefit manager's license shall  expire  thirty-six
months  after  the  date of issue. Every license issued pursuant to this
section may be renewed for the ensuing period of thirty-six months  upon
the filing of an application in conformity with this subsection.
(e) If an application for a renewal license shall have been filed with
the  superintendent  at least two months before its expiration, then the
license sought to be renewed shall continue in  full  force  and  effect
either  until  the issuance by the superintendent of the renewal license
applied for or until five  days  after  the  superintendent  shall  have
refused  to  issue such renewal license and given notice of such refusal
to the applicant.
(f)  The  superintendent  may  refuse  to  issue  a  pharmacy  benefit
manager's license if, in the superintendent's judgment, the applicant or
any  member,  principal,  officer  or  director of the applicant, is not
trustworthy and competent to act as or in  connection  with  a  pharmacy
benefit  manager,  or  that  any  of  the  foregoing has given cause for
revocation or suspension of such license, or has failed to  comply  with
any prerequisite for the issuance of such license.
(g) Licensees and applicants for a license under this section shall be
subject   to   examination   by  the  superintendent  as  often  as  the

superintendent may deem it expedient. The superintendent may  promulgate
regulations  establishing  methods  and  procedures for facilitating and
verifying compliance with the requirements  of  this  section  and  such
other regulations as necessary.
(h)  The  superintendent  may  issue  a  replacement  for  a currently
in-force license that has been lost or destroyed. Before the replacement
license shall be issued, there shall be on file in  the  office  of  the
superintendent  a  written  application  for  the  replacement  license,
affirming under penalty of perjury that the original  license  has  been
lost or destroyed, together with a fee of eight hundred dollars.
(i) No pharmacy benefit manager shall engage in any practice or action
that  a  health  plan  is  prohibited  from engaging in pursuant to this
chapter.