Pharmacy Benefit Manager Licensing

Pharmacy Benefit Manager (PBM) Licensing

Effective 10-01-2021, North Carolina Senate Bill 257 revises sections of Chapter 58  - Article 56 Third Party Administrators, and Article 56A Pharmacy Benefit Management. These changes promote pricing transparency for patients and establish standards and criteria for the regulation and licensure of PBMs providing services for Health Benefit Plans in North Carolina as defined in NCGS 58-56A-1(3).

Licensing Forms and Instructions

The procedures and forms for licensing as a PBM are currently being developed.  Instructions will be posted when procedures are finalized.

  • In the meantime, PBMs should continue to follow the Third Party Administrator (TPA) licensing procedures

TPA Licensing

  • A PBM contracting only with single employers with self-funded health plans must continue to register as a Third Party Administrator (TPA)

TPA Registration

Please contact Rebecca Hill at Rebecca.Hill@ncdoi.gov with any questions. If you wish to be contacted via email when the instructions are posted on our website, please provide a valid email address to Ms. Hill for this purpose.

https://www.ncdoi.gov/licensees/life-and-health-licensing/pharmacy-benefit-manager-licensing