Pharmacy Benefits Manager Licensing

Companies

Effective January 1, 2023, all Pharmacy Benefits Managers (PBMs) are required to be licensed if operating in Kansas. See House Substitute for Senate Bill 28 and the Pharmacy Benefits Manager Licensing Reform Implementation FAQ for additional information.

PBM Licensing Information and Instructions

Initial License

Pharmacy Benefits Managers Checklist

To apply for a Kansas Pharmacy Benefits Manager (PBM) license, the applicant must satisfy or complete the following requirements:

  1. The applicant must be organized as a corporation, partnership, limited liability company, limited liability partnership or sole proprietorship. If applicable, register your business entity with the Kansas Secretary of State’s office.[1] NOTE: The applicant is required to submit a Certificate of Good Standing to the Department via email to KDOI.rf@ks.gov with “Certificate of Good Standing” in the subject of the email.
  2. Submit the NAIC Uniform Application for Business Entity License online via the National Insurance Producer Registry (NIPR). Submit background question responses and administrative actions to the NIPR Data Warehouse, if applicable.
  3. At the time of application, the applicant must pay an application fee of $2,500 by credit card or electronic check through NIPR. The application fee is nonrefundable.
  4. Submit an EIN Verification Letter (147C) issued by the IRS or any other acceptable document issued by the IRS verifying the entity’s FEIN by email to KDOI.rf@ks.gov or upload to the attachments warehouse. This document is required for all business entity types, including sole proprietorships. To obtain a copy of the EIN Verification letter call 1-800-829-4933.
  5. The following information must be submitted electronically to the Department via the Contacts Form fillable form:
    1. Name, address, official position and professional qualifications of each individual who is responsible for the conduct of the affairs of the PBM, including all members of the board of directors, board of trustees, executive committee, other governing board or committee, the principal officers in the case of a corporation, the partners or board members in the case of a partnership or association.
    2. Name and address of the applicant’s agent for service of process in the state of Kansas.
    3. Name, address, phone number, email address and official position of the PBM employee who will serve as the primary contact for the Department.
  6. Complete and electronically submit the Network Adequacy Report Form.
  7. Submit the following documents to the Department via email to KDOI.rf@ks.gov with “PBM” in the subject line:
    1. A copy of the PBM’s corporate charter, articles of incorporation or other charter documents.
    2. A template contract, which shall include the dispute resolution process, involving an independent factfinder between: 1) the PBM and the health insurer; or 2) the PBM and the pharmacy or the pharmacy’s contracting agent.

Review by the Department

The Department has 90 days after receipt of the applicable license fee, the network adequacy report and a “completed application” to review the applicant’s qualifications and either issue a license for applicants who meet the requirements for licensure or issue a denial letter, documenting reasons for the determination. An application is complete after receipt by the Department of the application form submitted through NIPR and the Department has received all other required supporting documents and information.

The Department recommends that currently registered PBMs should begin the license application process as soon as possible after October 1, 2022, to allow sufficient time for the application to be completed and be reviewed by the Department prior to January 1, 2023.

1 Sole Proprietors and partnerships are not required to file/register with the Secretary of State.

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License Renewal

A Kansas PBM license must be renewed annually by March 31. A licensee is able to begin the renewal process after January 1st.  NOTE: PBMs that receive an initial license effective January 1, 2023, are required to renew the license, and pay the renewal fee, by March 31, 2023.

To renew a Kansas Pharmacy Benefits Manager license, you must satisfy or complete the following requirements:

  1. Submit an NAIC business entity renewal application through NIPR.
  2. At the time you renew, you must pay a renewal fee of $2,500 by credit card or electronic check through NIPR. The renewal fee is nonrefundable.
  3. The Department will verify whether the business entity is active and in good standing with the Kansas Secretary of State (if applicable). Agencies should verify with the Office of the Secretary of State that they meet this requirement prior to filing a renewal application.  Agencies that are required to be registered with the Secretary of State and are not or are not active and in good standing will not be renewed by the Department.
  4. Submit an EIN Verification Letter (147C) issued by the IRS or any other acceptable document issued by the IRS verifying the FEIN by email to KDOI.rf@ks.gov or upload to the attachments warehouse. This document is required for all business entity types, including sole proprietorship. To obtain a copy of the EIN Verification letter call 1-800-829-4933 (option 1 for English or 2 for Spanish) then option 2.
  5. Complete and electronically submit the Network Adequacy Report Form.

Failure to file a renewal application, pay the renewal fee, or be found to be active and in good standing with the Secretary of State (if applicable) by March 31st of each year will result in the expiration of the agency license. The agency will be required to apply for a new license by submitting an NAIC Uniform Application for Business Entity License and paying the application fee online via NIPR.

Maintaining Your Pharmacy Benefits Manager License

Requirements for maintaining your Pharmacy Benefits Manager license in Kansas:

  • You must keep a current email address on file with the Department. Renewal notices and other communications are only sent electronically via email.
  • You are required to notify the Department of any changes in business address, mailing address, telephone number, and email address. These must be reported via a Contact Change Request (CCR) through NIPR. Do not notify the Department directly of these changes.
  • Licensees must notify the Department of any material changes in the following information within 90 days. Licensees must electronically submit these updates via the Contacts Form.  Failure to timely provide notice of these changes may result in a penalty of $500 against the licensee.
      1. The name, address and telephone number of the pharmacy benefits manager.
      2. Name, address, official position and professional qualifications of each individual who is responsible for the conduct of the affairs of the PBM, including all members of the board of directors, board of trustees, executive committee, other governing board or committee, the principal officers in the case of a corporation, the partners or board members in the case of a partnership or association.
      3. The name and address of the applicant’s agent for service of process in the state.
      4. The name, address, phone number, email address and official position of the employee who will serve as the primary contact for the department.
      5. The pharmacy benefits manager’s corporate charter, articles of incorporation or other charter document.
      6. The template contract required in K.S.A. 40-3823(b)(6).
      7. The network adequacy report required in K.S.A. 40-3823(b)(7).