NM Insurance Bulletin 2023-001
PHARMACY BENEFIT MANAGER LICENSURE AND LICENSURE RENEWAL REQUIREMENTS FOR 2023 AND THEREAFTER
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
SUPERINTENDENT OF INSURANCE
Russell Toal
DEPUTY SUPERINTENDENT
Jennifer A. Catechis
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501
Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI
www.osi.state.nm.us
BULLETIN 2023-001
January 3, 2023
TO:
ANY PHARMACY BENEFIT MANAGER SEEKING LICENSURE OR
RENEWAL OF LICENSURE PURSUANT TO THE PHARMACY BENEFIT
MANAGER ACT SECTION 59A-61-1 ET SEQ. N.M.S.A. 1978
RE:
PHARMACY BENEFIT MANAGER LICENSURE AND LICENSURE
RENEWAL REQUIREMENTS FOR 2023 AND THEREAFTER
This Bulletin applies to any Pharmacy Benefit Manager (PBM) seeking licensure or
renewal of licensure in New Mexico pursuant to the Pharmacy Benefit Manager Act Section 59A-
61-1 et seq. N.M.S.A. 1978. PBM licensure renewal and annual reports are due before March 1,
2023. The requirements for applying for, or renewing a license, payment of fees, and submitting
the annual report are outlined below.
All checklists, forms, and filing templates referenced below are available on OSIās
pharmacy benefit manager website:
https://www.osi.state.nm.us/pages/bureaus/pbm/resources/licensure-requirements-and-templates.
I.
Fees:
Fees shall be submitted in SERFF with the filings for PBMs. Access SERFF at
https://www.serff.com/. The fee shall be attached to the corresponding filing type. For example,
in the Filing Fees Tab in SERFF, list $1,000.00 in conjunction with a PBM Application filing for
a PBM that is newly applying for licensure. See the table below for more information:
Citation
Fee
TOI
SUB-TOI/
Filing Type
SERFF Filing
Label
Non-refundable
new application
fee 59A-6-
1(AA)(1)
$1,000
PBM
PBM Application/PBM
Application
Application
Form
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Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501
Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI
www.osi.state.nm.us
Non-refundable
renewal
application fee
59A-6-1-(AA)(2)
$500
PBM
PBM Application/PBM
Application
Application
Form
Annual report
59A-6-1(AA)(3)
$200
PBM
PBM Annual Report/PBM
Annual Report
Annual Report
Template
Organizational
documents
amendments
59A-6-1-(AA)(4)
$200
PBM
PBM
Application/Organizational
Documents
Articles of
Incorporation or
Partnership's
Partnership
Agreement and
Change of
Ownership Form
as applicable
Informational
amendments
59A-6-1-(AA)(5)
$100
PBM
PBM Application/Change
of Ownership
Change of
Officers Form
Name Change
$30 plus a
$50 late
filing fee if
the entity
has NOT
filed form
within 30
days of
change.
PBM
PBM Compliance
Reporting/Other
Compliance Documents
Name Change
Form
II.
Requirements for application for licensure:
A.
Fee. Fees for application and filing of supporting documents are listed above, filed
in SERFF.
B.
Application. The following documents shall be completed and filed in SERFF as
a part of the licensure application as stated below. The completed documents shall be filed as
Supporting Documents in the PBM TOI, PBM Application SUB-TOI. To request confidentiality
of documents, see the section on Confidentiality Request below the tables. Failure to timely file
all the required documents may result in the rejection of an application for licensure or renewal.
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Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501
Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI
www.osi.state.nm.us
Filing Requirement
SUB-TOI
Filing Type
Notes
Application Form
PBM
Application
PBM
Application
Attach fee to this main filing. Include
any current SBS license number in
the application. See OSIās PBM
website for the form.
Questionnaire
PBM
Application
PBM
Application
File this as a Supporting Document
to the PBM Application. See OSIās
PBM website for the form.
Organizational documents
PBM
Application
Organizational
Documents
Pay required fee. Documents shall be
certified by the secretary in the
PBMās home state. Contact the New
Mexico Secretary of State at (505)
827-4508 for more information about
business licenses in New Mexico.
Background Checks
Via Email
Via Email
Background checks shall be submitted
by the vendor to: OSI-
PBMAnnualReport@osi.nm.gov with
the subject āBackground Checksā.
Background checks shall only be
submitted for all officers of a newly
licensed PBM, and any new officers,
partners, or board members of
previously licensed PBMs.
Contact Processing Form
PBM
Application
PBM
Application
File this as a Supporting Document
to the PBM Application. See OSIās
PBM website for form.
Change of Ownership Form
or Informational Change, if
applicable
PBM
Application
Change of
Ownership
Pay required fee. File this as a
Supporting Document to the PBM
Application. See OSIās PBM website
for the form.
Certification of Good
Standing
PBM
Application
PBM
Application
Certification that PBM is in good
standing in their home state. File this
as a Supporting Document to the
PBM Application.
List of States in Which
Licensed
PBM
Application
PBM
Application
Please include license number for
each state. File this as a Supporting
Document to the PBM Application.
Management List
PBM
Application
PBM
Application
File this as a Supporting Document
to the PBM Application
List of Subsidiaries
PBM
Application
PBM
Application
File this as a Supporting Document
to the PBM Application
Financial Statements
PBM
Application
PBM
Application
File this as a Supporting Document
to the PBM Application
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Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501
Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI
www.osi.state.nm.us
II.
Annual Report Requirements:
A.
Fee. Fees for submission of the Annual Report and filing of supporting
documents are as stated above in the table related to filing in SERFF.
B.
Annual Report. The following documents shall be completed and filed in SERFF
as a part of the Annual Report as listed below. The completed documents shall be filed as
Supporting Documents in the PBM TOI, PBM Annual Report SUB-TOI. The PBM may mark all
Annual Report documents confidential in SERFF. See the checklist on the OSI PBM website for
additional information on Annual Reporting Requirements. Failure to timely file all the required
documents may result in the rejection of the application for licensure.
Filing Requirement
Notes
Annual Report Template
File with fee. File this as a Supporting Document to the PBM
Annual Report
Attestation of No Charges
File this as a Supporting Document to the PBM Annual
Report
Attestation of No Steering
File this as a Supporting Document to the PBM Annual
Report
Audit Reporting
File this as a Supporting Document to the PBM Annual
Report
Clean Claims
File this as a Supporting Document to the PBM Annual
Report
Client/Business Relationship
Reporting
File this as a Supporting Document to the PBM Annual
Report
Client Contract
File this as a Supporting Document to the PBM Annual
Report
Consumer Notice
File this as a Supporting Document to the PBM Annual
Report
Drug Formulary Reporting
File this as a Supporting Document to the PBM Annual
Report
MAC Appeal Compliance
File this as a Supporting Document to the PBM Annual
Report
Non-Discrimination Policy
File this as a Supporting Document to the PBM Annual
Report
Pharmacist Grievance and
Complaint Reporting
File this as a Supporting Document to the PBM Annual
Report
Pharmacy and Therapeutics
Committee
File this as a Supporting Document to the PBM Annual
Report
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Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501
Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI
www.osi.state.nm.us
Provider Contract
File this as a Supporting Document to the PBM Annual
Report. This may be the same as the Provider Manual. If this
is the case, file the document as the Provider Contract.
Provider Manual
File this as a Supporting Document to the PBM Annual
Report. This may be the same as the Provider Contract. If this
is the case, file the document as the Provider Contract.
Website Information for
Complaint and Appeals
File this as a Supporting Document to the PBM Annual
Report
III.
Confidentiality Requests:
A PBM can request confidentiality for licensing and annual reporting documents pursuant
to Bulletin 2022-001 in accordance with 13.10.30.8(A)(13), 13.10.30.17(A), and 13.10.30.21
NMAC.
See
the
confidentiality
procedures
outlined
here:
https://www.osi.state.nm.us/pages/bureaus/life-and-health-division/resources/confidentiality.
Bulletin 2022-001 can be accessed here: https://www.osi.state.nm.us/news/bulletins/bulletin-
2022-001.
Requests for confidentiality must be submitted to the OSI prior to the documentās
submission in SERFF. When a confidentiality request is granted, the PBM shall upload both the
approved determination and the underlying documents to SERFF. The PBM must apply
confidentiality protections in SERFF at the time of the filing. If confidentiality is not applied at
the time of filing, the documents will be publicly accessible. Please note that if a document is
flagged as confidential in SERFF without an approved determination uploaded to SERFF, the
confidentiality tag will be removed and the document will be publicly accessible.
P&T Committee minutes are deemed confidential in accordance with 13.10.30.18 (C)
NMAC, and the PBM may apply a confidentiality tag to P&T meeting minutes at the time of
uploading. If a PBM does not apply a confidentiality tag to P&T minutes when uploaded into
SERFF, they will be publicly accessible.
IV.
SERFF Training. SERFF training is available via the National Association of Insurance
Commissioners. See https://www.serff.com/serff_tutorials.htm.
V.
Failure to Submit. Failure to timely apply for or renew a license or to submit the annual
report may result in penalties pursuant to Section 59A-1-18, NMSA 1978.
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Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501
Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI
www.osi.state.nm.us
Any questions can be directed to the PBM Program Coordinator at
OSI-PBMAnnualReport@osi.nm.gov or (505) 670-8273.
ISSUED this 3rd day of January, 2023.
__________________________________
RUSSELL TOAL
Superintendent of Insurance