- Home to DLR
- Home to Division of Insurance
- About Us
- Application, Forms & Filing Requirements
- Company Address Services
- Company Rate and Form Filing Search
- Complaint Process
- Enforcement/Administrative Actions
- External Review Process
- Laws, Administrative Rules, Bulletins, Memorandums
- Market Share Reports
- Partners in Education Tax Credit Program
- Premium Tax Information
- Publications (Alerts, Newsletters)
- Report Insurance Fraud
- SBS Industry Tools
- Securities Regulation
- Sign up for Alerts & Bulletins
- Useful Links
- Workers' Compensation
- Contact the Division of Insurance
Division of Insurance
Pharmacy Benefits Management/Pharmacy Benefits Manager (PBMs)
Pharmacy Benefits Management, defined in SDCL 58-29E-1, is the procurement of prescription drugs at a negotiated rate for dispensation within this state to covered individuals, the administration or management of prescription drug benefits provided by a third-party payor for the benefit of covered individuals, or any of the following services provided with regard to the administration of pharmacy benefits:
(a) Mail service pharmacy;
(b) Claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to covered individuals;
(c) Clinical formulary development and management services;
(d) Rebate contracting and administration;
(e) Certain patient compliance, therapeutic intervention, and generic substitution programs; and
(f) Disease management programs involving prescription drug utilization.
A Pharmacy Benefit Manager performs pharmacy benefit management, pursuant to a contract or other relationship with a thir-party payor and includes:
(a) A person acting in a contractual or employment relationship for a pharmacy benefit manager while providing pharmacy benefit management for a third-party payor; and
(b) A mail service pharmacy.
A person may not act as a pharmacy benefit manager in this state without a license to operate as a third party administrator pursuant to chapter 58-29D. Sections 58-29D-26, 58-29D-27, and 58-29D-29 do not apply to pharmacy benefits managers.
PBMs are required to submit license applications through the National Insurance Producers Registry (NIPR) with supporting documentation to be submitted via the NIPR Attachment Warehouse. See the PBM License Application Checklist for additional information.
Each licensed PBM must file an annual renewal on or before July first of each year. Failure to file a renewal will result in lapsing of the license.
Pharmacy Benefits Manager Listing
Licensure of a specific entity can be verified through SBS License Look Up Search.