Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-95 - Pharmacy Benefits Managers
Section 0780-01-95-.13 - LICENSING

Universal Citation: TN Comp Rules and Regs 0780-01-95-.13

Current through September 24, 2024

(1) No person or entity may act as a PBM in this state without first receiving a PBM license from the Department in accordance with T.C.A. § 56-7-3113 and this rule.

(2) In addition to the requirements of T.C.A. § 56-7-3113, an applicant must also submit the following as directed by the Department as part of an application for a PBM license, which must be current as of the date of submission:

(a) Any trade names or d/b/a names used by the applicant;

(b) The name and address of the applicant's agent for service of process in this state;

(c) The applicant's federal employer identification number;

(d) Copies of the original, certified organizational documents of the applicant, including but not limited to the following, as applicable:
1. Articles of incorporation or association, as applicable, and all amendments;

2. Partnership agreements and all amendments;

3. Trade name certificates and all amendments;

4. Trust agreements and all amendments;

5. Shareholder agreements and all amendments;

6. Bylaws and all amendments; and

7. For PBMs not domiciled in Tennessee, proof of registration with the Tennessee Secretary of State;

(e) Certification that all information submitted pursuant to this paragraph is true and accurate to the best of the applicant's knowledge;

(f) An audited financial statement accompanied by an audit report prepared by a certified public accountant for the applicant's most recently ended fiscal year for which an audited financial statement is available; and

(g) Any other documentation or information requested by the Department.

(3) An applicant-or upon approval of an application and issuance of a license, a PBM-shall report any material changes in the information provided pursuant to paragraph (2) to the Department within sixty days of the change.

(4) When submitting a renewal application, a PBM must only submit information required under paragraph (2) that was either not previously submitted in a prior application, or that has changed since it was last submitted. For information required under paragraph (2) that was previously submitted and has not since changed, a PBM may submit a certification stating this, along with references to the particular paragraphs or subparagraphs of this rule to which the certification applies.

(5) Licenses no less than one calendar day and no more than thirty calendar days past their expiration date shall be considered delinquent but may still be renewed pursuant to paragraph (4) of this rule.

(a) For licenses that have been expired no less than one day and no more than thirty calendar days, the PBM may submit a renewal application pursuant to paragraph (4) of this rule, along with the delinquent renewal fee required under Rule 0780-01-95-.07(4). This delinquent renewal fee shall be in addition to the renewal fee required under T.C.A. § 56-7-3113(e)(1).

(b) For licenses that have been expired more than thirty calendar days, the PBM must submit a new application pursuant to paragraph (2) of this rule.

(c) Approval of a delinquent renewal application shall be retroactive to the date the PBM submitted the application. However, approval of a delinquent renewal application shall not relieve the PBM of any penalties or other disciplinary action for unlicensed activity that occurred between the time the PBM's license expired and the PBM submitted a delinquent renewal application.

(6) A PBM shall report to the Commissioner any administrative, judicial, or disciplinary action taken against the PBM in another jurisdiction or by another governmental agency in this state within sixty days of the final disposition of the matter. The report must include a copy of any order entered or other relevant legal document that contains the terms of the resolution of the matter reported.

Authority: T.C.A. § 56-7-3101.

Disclaimer: These regulations may not be the most recent version. Tennessee may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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