PHARMACY BENEFIT MANAGERS
LICENSING AND APPLICATIONS
WHEN DOES MY LICENSE RENEW?
Pharmacy Benefit Manager licenses renew annually on the month and day on which the license was issued.
WHAT ARE THE LICENSE FEES?
Both new license application fees and renewal fees are $500.
HOW DO I APPLY FOR A LICENSE?
Applications for licensure may be made through Sircon ↗. The licensing fee is $500. Please provide documentation of administrative proceedings not previously reported to the Wyoming Department of Insurance, the company's written appeals process for audits, and procedures for handling MAC appeals.
DO I NEED A LICENSE IF I ONLY PROVIDE SERVICES TO FEDERAL PROGRAMS, WORKERS' COMPENSATION, OR ERISA PLANS?
Yes, pursuant to W.S. §26-52-102 (a)(vii), a PBM is any entity that contracts with a pharmacy or pharmacy’s designee who holds a contract with the PBM on behalf of an insurer or third party administrator to administer or manager prescription drug benefits.
COMPLAINTS
WHO CAN FILE A COMPLAINT AGAINST A PBM?
Pharmacists and PSAOs may file a complaint against any PBM conducting business as a PBM in the state of Wyoming.
HOW DO I FILE A COMPLAINT?
Complaints can be made through Sircon's Consumer Complaint Portal ↗. Please read "What to Know Before You File a PBM Complaint" before filing a complaint.
CAN I FILE A COMPLAINT AGAINST A PBM FOR ANY ISSUE?
No. At this time the DOI only has authority to investigate matters regarding licensing, audits, MAC pricing and payment alternatives, transparency, and prompt payment (W.S. §§26-52-103 through -107 and §§26-52-201 through -203).
CAN I CALL TO SUBMIT A COMPLAINT?
Yes. However, the Health Program Manager will ask you to follow up by filing the complaint online. This will allow you to upload any required or necessary documentation for the manager to investigate your complaint. It will also assign a case number in the portal. You can then use that case number to check the status of your case.
CAN THE DOI INVESTIAGE COMPLAINTS AGAINST PBMS FOR FEDERAL PROGRAMS?
No. The DOI does not have authority to investigate a complaint against federal programs such as Medicare, Medicaid, Tricare, CHIP, or others like them. However, the DOI will assist you by providing contact information on where you can file a complaint.
WHAT HAPPENS AFTER A COMPLAINT IS FILED?
The Health Program Manager will review the complaint and documentation. They will determine if additional information is needed and reach out to you if necessary. The Health Program Manager will also determine if this is a matter in which we have authority to enforce.
If the Health Program Manager determines an investigation is warranted they will begin the internal review process. You will be kept apprised of the status throughout the process.
If the Health Program Manager determines the DOI does not have the authority to investigate they will respond in writing notifying you of the determination and how that determination was reached. They will also provide you with any known options available to you regarding your complaint.