New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 30 - PHARMACY BENEFITS MANAGERS › Section 13.10.30.8 - REQUIREMENTS FOR LICENSURE

Current through Register Vol. 35, No. 13, July 16, 2024
A PBM shall not conduct any operation or provide any service
				  in New Mexico unless it holds a valid PBM license issued by the
				  superintendent.
A. A PBM shall apply
				for a license by submitting a complete application package on a form, and
				pursuant to the directions, prescribed by the superintendent. The application
				package shall include:
(1) The non-refundable
				filing fee prescribed by Paragraph (1) of Subsection AA of Section
				59A-6-1 NMSA 1978
				for filing an application for a license.
(2) The name of the legal entity, federal
				employer identification number ("FEIN"), business address, phone number and
				state of residency.
(3) The name,
				business address, phone number and e-mail address of a contact person
				designated by the PBM to respond to grievances.
(4) The name, business address, phone number
				and e-mail address of a contact person designated by the PBM to respond to
				inquiries by the superintendent.
(5) Proof of current authority from the
				controlling New Mexico regulator to conduct business in New Mexico.
(6) For each partner, managing member, and
				director, as applicable, the application package shall include a background
				investigation report through a vendor approved by OSI upon initial application.
				Changes in leadership shall submit a background investigation report at the
				time of renewal of license.
(7) For
				the preceding 10 years, a statement of whether the application has:
(a) been refused a registration, license or
				certification to act as or provide the services of a PBM or third-party
				administrator; or
(b) had any
				registration, license or certification denied, suspended, revoked or
				non-renewed for any reason by any state or federal entity; and
(c) if either (a) or (b) apply, the PBM shall
				separately attach the details of each such action, including the date, nature
				and disposition of the action.
(8) A statement of whether the applicant in
				the most recent 10 years had a business relationship terminated for any
				admission, legal finding, or judgement of fraudulent or illegal activities in
				connection with the administration of a pharmacy benefits plan and a
				description of each termination.
(9) A list of all New Mexico clients serviced
				by the PBM.
(10) A list of each
				regulatory enforcement action against the PBM in any other state for the
				previous 10 years.
(11) The
				application shall be shall be signed and verified by an officer, director,
				managing member, or partner, as applicable, of the PBM.
(12) Any other information that is deemed
				necessary by the superintendent in evaluating the application to evidence
				compliance with Chapter 59A, Article 61 NMSA 1978 or the requirements of rules
				promulgated by the superintendent.
(13) Confidentiality requests by an applicant
				are governed by the superintendent's bulletin 2022-001 or any superseding
				bulletin or rule.
(14) The
				application package, except for the application fee, shall be submitted as
				directed by the superintendent. After the application has been approved or
				rejected by the PBM program coordinator, the applicant shall pay the
				application fee through NIPR. Failure to pay the application fee for a rejected
				application will preclude licensure or renewal.