What is a pharmacy benefits manager?

A pharmacy benefits manager is a third-party administrator (TPA) of prescription drug programs for insurers and employers who pay a fee to the PBM for their services. PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts with drug manufacturers and rebates, etc. PBMs manage health care plans for commercial insurance plans, self-insured employer plans, Medicare Part D plans, state government employee health plans and Medicaid managed care organization plans.

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1. What is a pharmacy benefits manager?
2. Are there PBMs already licensed in South Carolina?
3. What does the new South Carolina law do?
4. Will the Department promulgate new regulations?
5. My business is currently licensed as a Third Party Administrator (TPA). What do I need to do to transition to a PBM license?
6. What happens if a PBM does not have a PBM license by January 1, 2021?
7. Is completion of the PBM Application Requirements Checklist required for PBM licensure?
8. Can the PBM application be filed electronically?
9. Can the application be filed manually?
10. What happens when all requirements for PBM licensure are met?
11. Does a PBM need a TPA license in addition to a PBM license?
12. How can a PBM submit a name/address change?