Prescription Drugs

Pharmacy Benefit Managers and Drug Prices


What are Pharmacy Benefit Managers?

Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits. PBMs are intermediaries that operate between your health insurance company, which the PBM works for, and the pharmacy, where you fill a prescription. The PBM reimburses the pharmacy for dispensing the prescription.

File a Complaint About a PBM

Consumers and pharmacies can be connected with PBMs to resolve problems. DFS sends complaints that we receive about PBMs to those PBMs for a response. If another agency can help you, we will let you know.

If you are having a problem with a PBM, submit a complaint to the Department via email to [email protected].

What You Will Need to Submit

Save all communications you have with the PBM. Gather all the information and documents that you will submit with your complaint.
You must provide the following as part of your complaint:

  • Your full name, email, and address
  • The name of the PBM
  • The name of the health insurance company
  • The pharmacy name and address
  • A description with as much detail as possible about the reason for your complaint
  • Copies of any communications you have had with the PBM
  • Pharmacies must also provide the pharmacy NCPDP

You do not need to be represented by an attorney to file a complaint. However, the Department cannot act as your attorney or give you legal advice, recommend a health insurance company, PBM, or pharmacy, or provide medical advice.

Complaints About Significant Price Increases for Prescription Drugs

If you are experiencing a dramatic increase in the cost of a prescription drug, you can Report a Drug Price Spike to the Department.

Complaints About Health Insurance Companies

If you are having a problem with a health insurance company, you can File a Complaint with the Department.