Department of Financial Services’ Office of Pharmacy Benefits Concludes Information-Gathering Under New Authority  

Department Requests Information From Pharmacies and Pharmacy Benefit Managers About Pharmacy Audit Process 

Today the Department of Financial Services’ (“Department”) Pharmacy Benefits Bureau (“PBB”) announced a final request for public engagement as the Department looks to develop nation-leading regulatory standards for Pharmacy Benefit Managers (“PBMs”).  

As a regulator dedicated to data-based rulemaking, DFS has prioritized extensive outreach to all interested parties over the course of the past year including consumers, independent and chain pharmacies, prescription drug plan sponsors and insurers, and the PBM industry.  Today’s request asks for information on PBM audits of pharmacies, which are meant to eliminate or reduce fraud, waste, and abuse, but often are overly burdensome and costly without meeting this intended goal. Instead, pharmacy owners are taken away from the work of providing healthcare, requiring them to review and defend claims from a number of years in the past at the sole direction of PBMs without justification. The information collected will inform the scope of regulations necessary to ensure audits follow a clear and transparent process and have guardrails in place to meet the goal of preventing fraud, misuse, and waste. The Department is in the process of developing a series of PBM regulations that together will form the most comprehensive regulatory framework in the country.   

“It is critically important that we engage with all stakeholders and make policy decisions based on facts and market data.  That is why I directed the PBB staff to commence a wide-ranging information gathering campaign as we establish, for the first time, the rules of the road for PBMs operating in New York,” said Superintendent Harris. “DFS is committed to putting in place rules which create consistent standards and a transparent process for audits, preventing predatory and unfair practices.”  

All interested parties are encouraged to provide feedback on the Request for Public Comments and are reminded that the PBB is always available to accept and investigate complaints of PBM misconduct via email at [email protected]. Additionally, DFS is empowered to investigate significant spikes in the price of prescription drugs. Anyone experiencing a spike in the cost of drugs is encouraged to reach out to the PBB at [email protected].