Application Process Transparency - Pharmacy Benefit Manager Permit

Every pharmacy benefit manager that does business in this state or pays for benefits for a beneficiary through a pharmacy benefit management plan shall be licensed or permitted. 

Fee: $1,000.00 for two-year permit. To be paid with submission of the online application. 

Application: Application for New Pharmacy Benefit Manager Permit. This application is available online through the Online Services Portal.

Application Preview

Required Attachments (Checklist): 

• W9 or FEIN letter is required for the legal entity identified as the direct owner.
• A copy of the verification from the Louisiana Secretary of State when located within the state.
• A copy of the verification from the resident Secretary of State and articles of incorporation.
• Verification that the entity is registered with the La. Dept. of Insurance as a third-party administrator.
• Identification of ownership using Form 71 ~ Facility Ownership Disclosure Form
• Identification of managing officers as outlined in the application. 
• Identification of any pharmacies under the same ownership.
• If the applicant provided an affirmative response to any questions regarding prior actions:
• Letter of explanation.
• Certified copies of documents from relevant court or government agency.

Board Review: A review of prior actions and criminal history, reported by the applicant, is completed when all documents have been received and payment processed.

Criminal history may be used as a basis for denial. All factors outlined in LA:R.S. 37:2950 shall be considered.

Issuance: In the event that there are no matters preventing the immediate issuance, the board will issue the credential within fourteen business days of the final requirement being fulfilled.

Start the application process.

Inquiries regarding Pharmacy Benefit Manager Permits may be submitted to:

Sarah B. Stevens, Licensing Director - sstevens@pharmacy.la.gov