Memo regarding documentation of MAC appeals processes and pharmacy audit processes being added to PBM licensing applications

THE STATE OF WYOMING Mark Gordon Department of Insurance Jeffrey P. Rude Governor Commissioner 106 E. 6th Ave. ▪ Cheyenne, Wyoming 82002 Administration (307) 777-7401 ▪ Fax (307) 777-2446 ▪ https://doi.wyo.gov/ ▪ Licensing (307) 777-7319 ▪ Consumer Affairs (307) 777-7402 April 26, 2022 New Licensing & Renewal Application Requirements for Pharmacy Benefit Managers (“PBMs”) During Wyoming’s 2016 Legislative session, Wyo. Stat. § 26-52-103 and Wyo. Stat. § 26-52-104 were passed, requiring all PBMs operating in Wyoming to establish a written internal appeal process for PBM audits of pharmacies and an internal appeal process for resolution of disputed claims under the PBM’s established Maximum Allowable Cost (MAC) list, respectively. The statute went into effect on July 1, 2016. In accordance with this statute, the Department has elected, effective July 1, 2022, to begin requiring these procedures to be disclosed upon initial license application or upon application for license renewal by any PBM planning to operate in the state of Wyoming. A new field in the application will allow for upload of any documents related to these internal procedures, which the Department will review for sufficiency under the referenced statutes. An application will be deemed incomplete without these documents. Please contact the Department at 307-777-2450 if you have questions or to obtain more information. Sincerely, Bryce Hamilton Senior Policy & Planning Analyst Wyoming Department of Insurance