As defined in Health and Safety Code Section 1385.001, a “pharmacy benefit manager” is a person, business, or other entity that, pursuant to a contract with a health care service plan, manages the prescription drug coverage provided by the health care service plan. This includes, but is not limited to, the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to prescription drug coverage, contracting with network pharmacies, and controlling the cost of covered prescription drugs.
Instructions: How to Register as a Pharmacy Benefit Manager (PBM)
PBMs must submit a completed DMHC 10-242 form titled, "Application Form for Pharmacy Benefit Manager Registration” (PBM Registration Application), cover letter, and payment for the registration fee to the DMHC.
- PBMs must send the completed PBM Registration Application and cover letter via electronic mail to PBM.Registration@dmhc.ca.gov or U.S. Mail at DMHC-Office of Plan Licensing, ATTN: PBM Registration, 980 9th Street, Suite 500, Sacramento, CA 95814.
- PBMs must submit payment for the registration fee via check payable to “Department of Managed Health Care,” to DMHC-Office of Plan Licensing, ATTN: PBM Registration, 980 9th Street, Suite 500, Sacramento, CA 95814.
- PBMs are only required to send the PBM Registration Application via one method: either electronic mail or U.S. mail.
- DMHC will not begin processing a PBM Registration Application until payment for the registration fee is received.
- Please refer to APL 19-017 Pharmacy Benefit Management Services for more information.
Instructions: How to Amend Pharmacy Benefit Manager Registration Form
If there is a change in any of the information disclosed to the DMHC on the most recently submitted PBM Registration Application (i.e., an “Amendment to Application Form for Pharmacy Benefit Manager Registration” as referenced on Page 1 of the PBM Registration Application), the PBM must notify the DMHC of that change in writing within 30 days of that change pursuant to Section 1385.005, subdivision (g). When disclosing the respective change(s), the PBM should submit an amended PBM Registration Application and describe the specific changes in a cover letter.
Instructions: How to Surrender Pharmacy Benefit Manager Registration
PBMs must submit a cover letter stating their reason and intent to surrender, and payment for the surrender fee to the DMHC.
- PBMs must send the completed PBM surrender cover letter via electronic mail to PBM.Registration@dmhc.ca.gov or U.S. Mail at DMHC-Office of Plan Licensing, ATTN: PBM Registration, 980 9th Street, Suite 500, Sacramento, CA 95814.
- PBMs must submit payment for the surrender fee via check payable to “Department of Managed Health Care,” to DMHC-Office of Plan Licensing, ATTN: PBM Registration, 980 9th Street, Suite 500, Sacramento, CA 95814.
- PBMs are only required to send the PBM surrender cover letter via one method: either electronic mail or U.S. mail.
- DMHC will not begin processing a PBM surrender request until payment for the surrender fee is received.
Applicable Fees
Original PBM Registration Application:
- The DMHC will begin review of the original PBM Registration Application upon receipt of a flat filing fee of $3,500.
- The DMHC will also bill for time spent reviewing the PBM’s responses and changes requested by the DMHC at a variable hourly rate, depending on the reviewer’s classification, up to $500.
- The fees to review an initial PBM Registration Application are capped at $4,000.
Amended PBM Registration Application:
- After a PBM is registered with the DMHC, a PBM submitting changes to the DMHC pursuant to Section 1385.005(g) will be billed at a variable hourly rate, depending on the reviewer’s classification, and any of the PBM’s responses and changes requested by the DMHC. The fees to review an amendment to PBM Registration Application are not capped.
Surrender PBM Registration:
- If a registered PBM is requesting to surrender, the DMHC will begin review of the PBM's Surrender request upon receipt of a flat filing fee of $500.
Relevant Laws
Knox Keene Act (Health and Safety Code) sections 1385.001 through 1385.007
Resources
Contacts
Mail:
Department of Managed Health Care
Office of Plan Licensing
Attention: PBM Registration
980 9th Street, Suite 500
Sacramento, CA 95814
Email:
PBM.Registration@dmhc.ca.gov
Contact:
Questions or concerns regarding the Pharmacy Benefit Manager Registration process or a related matter from Plans should be directed to the Plan’s assigned Office of Plan Licensing reviewer.
Questions or concerns regarding the Pharmacy Benefit Manager Registration process or a related matter from PBMs should be directed to the Office of Plan Licensing at 916-324-9046 or at PBM.Registration@dmhc.ca.gov.