To: All Pharmacy Benefit Managers Doing Business in this State, and Other Interested Parties
From: Raymond G. Farmer, Director of Insurance
The purpose of this bulletin is to establish filing timelines for Pharmacy Benefit Managers (PBMs) applying for licensure under Article 21 of Chapter 71, Title 38 of the South Carolina Code of Laws. 2019 SC Act No. 48 (R. 68, S. 359), most of which becomes effective January 1, 2021, requires all PBMs currently operating in this state under licensure as Third-Party Administrators (TPAs) to be licensed as a Pharmacy Benefit Manager.
The South Carolina Department of Insurance (SCDOI) promulgated Regulation 69-77 to implement 2019 SC Act No. 48. This regulation provides that the SCDOI will publish a time frame for transitioning licenses from the TPA license to a PBM license. This bulletin is published in accordance with that requirement.
What follows is the timeline for such TPAs to submit the initial application, and all it requires, to provide pharmacy benefit manager services in South Carolina. Additionally, anyone entering the market as a PBM must be licensed to do so before providing pharmacy benefit manager services.
Filing Timeline for Transitioning TPA Licenses to PBM Licenses Under 2019 SC Act No. 48
Pharmacy Benefit Managers must be licensed as such beginning January 1, 2021 to operate in this State and provide pharmacy benefit manager services. The application window will begin on October 1, 2020 and the final deadline for all applications will be December 1, 2020. Any entity not properly licensed as a PBM on or after January 1, 2021 will be subject to administrative action pursuant to S.C. Code § 38-2-10 through § 38-2-30.
Application Timeline for Pharmacy Benefit Managers Transitioning Licensure
PBM Initial Application Begins October 1, 2020
PBM Initial Application Deadline* December 1, 2020
*Applications received after December 1, 2020 may result in a delay in the review process and are not guaranteed to have a license issued by January 1, 2021.
Filing Requirements for PBM License
PBM’s can apply online through nipr.com. All supporting documentation and $1000 initial application fee can be uploaded and submitted via the NIPR website.
PBM’s can download the paper PBM Application from the Department website. All supporting documentation can be emailed to PBMDept@doi.sc.gov. The initial application fee of $1000 can be made by check and mailed to the Department at the address above.
*Please be advised that any application which is deemed incomplete or unresolved for more than 30 days will be subject to denial, administrative action, or both.
Pursuant to Regulation 69-77, beginning in 2022, licenses shall be renewed annually no later than March 1st of each year by submitting a renewal application, a $500 renewal license fee, and all requisite supporting documentation. The renewal application window will begin 90 days prior to license expiration on March 1st of each year. Renewal applications submitted after March 1st will be subject to an initial license fee and may be subject to administrative action for any period of time for which the PBM license is not active.
PBMs should regularly check the PBM webpage (doi.sc.gov/pbm) for additional information relative to the application process and related information.
Questions regarding this bulletin, the application process or any PBM-related matters should be submitted via email to PBMDept@doi.sc.gov and include complete contact information (company name, phone number and email address for follow-up). You may also contact the Office of PBM Oversight via telephone at (803)734-0398.