PBM Licensure and Regulation Complaints

VPhA successfully introduced and passed legislation during the 2020 General Assembly session requiring licensure and regulations of Pharmacy Benefit Managers in Virginia. We thank the legislations chief patrons: Delegate Hodges, Delegate Samirah, Delegate O’Quinn, Delegate Head and Senator Edwards and Senator Pillion. The legislation took effect on July 1, 2020. The insurance complaint form used by the State Corporation Commission (SCC) was not user friendly and we’ve spent months working with the SCC on a new form. The new form is easier for pharmacies and patients to navigate and submit.

Additional information from the SCC:

Pharmacy Benefits Management

A pharmacy benefits manager is an entity that performs pharmacy benefits management – that is, administers or manages prescription drug benefits provided by a carrier for the benefit of covered individuals. It includes an entity acting for a pharmacy benefits manager in a contractual relationship in the performance of pharmacy benefits management for a carrier, nonprofit hospital, or third-party payor under a health program administered by Virginia. Pharmacy benefits management is now regulated by Virginia, which includes licensing, reporting and prohibited conduct.

File a complaint:
The Bureau of Insurance responds to complaints filed against pharmacy benefits managers (PBM) by insureds, patients, pharmacists and others, on matters within its regulatory authority.

To file a complaint against a PBM providing pharmacy benefits management services for commercial health plans under Virginia law, use the button below:

PBM Complaint Form

Provide as much information as possible. Attach copies of all supporting documentation to the completed complaint form, and keep the original documents for your records. Submit a separate complaint form for each PBM.

Send the completed form to the Bureau of Insurance using one of the following methods:

Email:        BOIPBMComplaints@scc.virginia.gov

Mail:        Pharmacy Benefits Manager Complaints
Virginia Bureau of Insurance
State Corporation Commission
P.O. Box 1157
Richmond, VA 23218

Fax:           804-371-9944

Complaints against a PBM servicing a Medicaid plan should be directed to the Department of Medical Assistance Services, and not be filed with the Bureau of Insurance.

We encourage you to have printed copies of the complaint form at your practice site and provide them to patients when an issues arises.