Section 760 IAC 5-2-1 - ApplicationAuthority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-18; IC 27-1-24.5-22; IC 27-1-25-11.1
Sec. 1.
A person must, before establishing or operating as a pharmacy benefit manager, apply to and obtain a license from the commissioner. The pharmacy benefit manager must submit an application on a form prescribed by the commissioner. The application must include the following information:
(1) The name or names under which the applicant conducts business.(2) A copy of the applicant's articles of incorporation or other business organization documents.(3) The following contact information: (A) The address of the principal place of business of the applicant.(B) The mailing address of the applicant.(C) The address of each office the applicant maintains in Indiana.(D) The primary licensing phone number of the applicant.(E) The primary licensing electronic mail address of the applicant.(4) The applicant's taxpayer or employer identification number.(5) A list by jurisdiction of the names under which the applicant has operated in the preceding five (5) years, including:(B) names of predecessors; and(C) if known, successor business entities.(6) A detailed explanation of adverse regulatory actions taken by a state or federal regulatory law enforcement or regulatory agency, or other reportable actions against the applicant or an owner, a partner, an officer, or a director of the applicant, or a member or manager of a limited liability company, according to the following: (A) Except as provided in clause (C), an adverse regulatory action means a:(iii) cease and desist order;(iv) prohibition order; or(v) suspension, probation, or revocation of a license or registration.(B) Except as provided in clause (C), a reportable action means a:(i) lawsuit or arbitration proceeding involving allegations of fraud, misappropriation or conversion of funds, misrepresentation, or breach of fiduciary duty;(iii) judgment rendered for overdue monies;(iv) bankruptcy proceeding;(v) delinquent tax obligation; or(vi) termination of a contract or other business relationship with an insurance company for alleged misconduct.(C) The applicant may exclude juvenile adjudications and the following misdemeanor convictions: (ii) Driving under the influence or driving while intoxicated.(iii) Driving without a license.(v) Driving with a suspended or revoked license.(D) The explanation must summarize the details of each incident and explain why the applicant believes the incident should not prevent the applicant from receiving a pharmacy benefit manager license. The applicant must submit copies of all relevant documents related to each incident. Additionally, when an incident involves: (i) a felony conviction involving dishonesty or breach of trust, the applicant must:(AA) disclose whether application was made for written consent to engage in the business of insurance in the applicant's home state as required by 18 U.S.C. 1033;(BB) disclose whether the consent was granted; and(CC) if granted, attach a copy of the consent approved by the applicant's home state;(ii) administrative proceedings, the applicant must provide:(AA) a written statement identifying the type of license, all parties involved (including their percentage of ownership, if any), and explaining the circumstances of the incident;(BB) a copy of the notice of hearing or other document that states the charges and allegations; and(CC) a copy of the official document which demonstrates the resolution of the charges or a final judgment;(iii) bankruptcy, the applicant must submit a statement summarizing the details of the indebtedness and arrangements for repayment; or(iv) a delinquent tax obligation, the jurisdiction or jurisdictions must be disclosed.(7) A list identifying the following and indicating percentage of ownership, if applicable: (A) Stockholders holding ten percent (10%) or more of the voting securities.(B) Investors holding a ten percent (10%) or greater interest.(D) Corporate officers and directors.(F) If an association, all of the members.(G) Affiliates, together with a chart showing the relationship of the applicant to all affiliates. An affiliate that is an insurance company shall be identified as such.(8) National Association of Insurance Commissioners (NAIC) biographical affidavits, as described in IC 27-1-25-11.1(b)(3), of all of the following: (C) Stockholders holding ten percent (10%) or more voting securities.(D) Investors holding ten percent (10%) or greater interest.(G) Members, if an association.(9) A statement describing the applicant's business plan, including the following information: (A) Staffing levels and activities proposed in Indiana and nationwide.(B) Details concerning the applicant's capability for providing a sufficient number of experienced and qualified personnel in the areas of pharmacy contracting, prescription drug benefit administration, pharmacy claims processing, prescription drug formulary development, prior authorization determination, prescription drug rebate administration, establishing pharmacy networks, and record keeping.(C) A list of all health plans for whom the applicant provides pharmacy benefit management services in this state and the date the applicant began providing pharmacy benefit management services to each health plan. The list must include the NAIC number of any insurance companies.(10) A copy of the written policies and procedures which demonstrate that the applicant has compliant processes established to adhere to both of the following: (A) The appeals and dispute resolution process as required by IC 27-1-24.5-22.(B) The requirements for maximum allowable cost pricing set forth in IC 27-1-24.5-22.(11) A list of states in which the applicant is currently licensed or registered as a pharmacy benefit manager, identifying the applicant's resident or home state, if applicable.(12) A list of states in which the applicant is currently engaged in business as a pharmacy benefit manager but is not required to be licensed or registered as a pharmacy benefit manager, identifying the applicant's resident or home state, if applicable.(13) A list of states where the applicant is currently applying for a license or registering as a pharmacy benefit manager.(14) Other information required by the commissioner to determine compliance with IC 27-1-24.5 or requirements of this article.Department of Insurance; 760 IAC 5-2-1; filed 2/23/2023, 9:48 a.m.: 20230322-IR-760220287FRA