Pharmacy Benefits Managers (PBMs)

Please be aware that all correspondence regarding an application for licensure will be conducted via email through our online system. The email address used for this correspondence is sbs@naic.org. We recommend saving this email address to ensure you receive any future system-generated emails. However, please do not reply to sbs@naic.org, as messages sent to that address will not be received. For any correspondence and documents you wish to submit regarding your license, please send them to PBMdept@doi.sc.gov.

INITIAL APPLICATION

You must complete the online application and pay the licensing fee ($1000.00) on NIPR. There are additional documents that must be sent to the Department of Insurance as part of the application. The online application, licensing fee, and the required documents listed on the application checklist must be legible, contain accurate information, be completed fully on updated forms, and submitted on the same day.  You must submit the application checklist with the required documentation via email to PBMdept@doi.sc.gov. (We cannot receive emails larger than 40MB. Please keep this in mind when sending documentation by email. You may have to send more than one email and/or combine documents in a zip file.) 

• Certificate of Existence (Certificate of Good Standing) with the South Carolina Secretary of State (https://sos.sc.gov/)

Your application will be deemed incomplete and denied if you fail to submit all the required information within thirty (30) days of completing your online application.  

RENEWAL APPLICATION

The renewal period will begin on December 1^st and will close on March 1^st of each year. We recommend applying early to allow sufficient time to address any potential issues and to prevent a lapse in your license and the incurrence of any reinstatement and/or penalty fees. 

You must complete the online renewal application on NIPR and pay the licensing fee ($500.00) on NIPR.  There are additional documents that must be sent to the Department of Insurance as part of the application.  

The online application, licensing fee, and the required documents listed on the application checklist must be legible, contain accurate information, be completed fully on updated forms, and submitted on the same day.  You must submit the checklist with the required documentation via email to PBMdept@doi.sc.gov. (We cannot receive emails larger than 40MB. Please keep this in mind when sending documentation by email. You may have to send more than one email and/or combine documents in a zip file.) 

Here is a Navigation tool for completing your online application on NIPR.

• Certificate of Existence (Certificate of Good Standing) with the South Carolina Secretary of State (https://sos.sc.gov/)

Your renewal will not be processed unless the Department of Insurance receives the online application, the licensing fee, and all the required documentation.  If you complete the online application and pay the licensing fee, but fail to submit the required documents by March 1^st, your renewal application will be rejected. If your license lapses, you may not conduct any PBM business until your license is reinstated/active. 

VOLUNTARY LICENSE SURRENDER

If you do not plan to renew your license or would like to surrender your license outside of the renewal, please complete the surrender form (Surrender Form) and send it via email or secure email to PBMdept@doi.sc.gov. 

Additional Forms

• PBM Electronic Application Guide
• PBM License Surrender Form
• PBM Change of Information Form

PBM Complaint Process

The South Carolina Department of Insurance (SCDOI), Office of PBM Oversight, has a complaint process for pharmacies or interested parties to file complaints* relating to Pharmacy Benefit Manager (PBM) services. You may submit a complaint and associated documentation via the SCDOI website, email, fax or mail. Please follow the steps below to file a complaint with the SCDOI, Office of PBM Oversight.

*For MAC and Audit related complaints, SC law requires pharmacies to make reasonable efforts to exhaust a PBM’s internal appeal requirements prior to filing a complaint with the SCDOI. You must provide a copy of the appeal outcome with your complaint submission or explain why you have not exhausted the internal appeals process as a part of your complaint submission.

To complete the PBM Complaint Form follow the steps below:

Submit via SCDOI Website:

1. Click PBM Complaint Form
2. Complete online form
3. Upload supporting documents directly to online form
4. Click "Submit" when complete

Submit via email:

1. Save PBM Complaint Form as a digital PDF document.
2. Complete fillable complaint form that was saved as digital PDF document. 
3. Email completed PBM Complaint Form and any supporting documents to the Office of PBM Oversight at PBMDept@doi.sc.gov..

Submit via fax:

1. Complete fillable PBM Complaint Form.
2. Print completed PBM Complaint Form.
3. Fax completed form and any supporting documents to the Office of PBM Oversight at (803) 737-1605.

Submit via mail:

1. Complete fillable PBM Complaint Form.
2. Print completed PBM Complaint Form.
3. Mail completed form and any supporting documents to 

Attn: Office of PBM Oversight
South Carolina Department of Insurance
1201 Main Street, Suite 1000
Columbia, SC 29201