Mich. Admin. Code R. 500.33

Current through Vol. 24-21, December 1, 2024

Section R. 500.33 - Application contents and fee; supplemental documents

Rule 3.

(1) To obtain a license, an applicant shall submit the following:

(a) An application on a form provided by the director.

(b) The supplemental documents required under section 11(2) of the act, MCL 550.821, and this rule.

(c) A nonrefundable application fee in an amount established by the director by bulletin. The director shall not adjust the application fee more than once per year.

(2) An applicant shall provide the following supplemental documents with an application submitted under subrule (1) of this rule:

(a) The documents required under section 11(2) of the act, MCL 550.821.

(b) A document providing the names, addresses, dates of birth, social security numbers, official positions, and professional qualifications of each individual who owns, legally or beneficially, 10% or more of the equity in the entity that is applying for a license.

(c) Each of the following:

(i) A list of every health plan or carrier on behalf of which the pharmacy benefit manager contracts with a pharmacy or a pharmacy services administration organization to provide pharmacy health services to individuals covered by the health plan or carrier.

(ii) A statement indicating all jurisdictions where the applicant has an application pending or has been registered, licensed, or otherwise certified to transact business as a pharmacy benefit manager.

(iii) A statement indicating whether:

(A) The pharmacy benefit manager or any individual responsible for the conduct of the affairs of the pharmacy benefit manager has had a pharmacy benefit manager certificate of authority or license denied or revoked for cause in another state.

(B) Any individual responsible for the conduct of the affairs of the pharmacy benefit manager has been convicted of, or has entered a plea of guilty or nolo contendere to, a felony without regard to whether adjudication was withheld.

(C) The pharmacy benefit manager's license has been suspended or revoked in another state.

(3) Any modification to the information required under subrule (2)(b) and (c) of this rule is significant, and, under section 11(3) of the act, MCL 550.821, the applicant shall file with the director a notice of modification to any information within 30 days after the modification.

Mich. Admin. Code R. 500.33

2023 MR 24, Eff. 1/2/2024