WHAT TO KNOW BEFORE YOU FILE A PBM COMPLAINT

If you would like to file a complaint on a Pharmacy Benefit Manager (PBM), do these things first:

• Follow the dispute resolution process outlined in your contract with the PBM.

• Keep records of all your communication with the PBM regarding your dispute. This would include:

  • Emails

  • Documentation supporting your dispute

  • Name(s) of contact(s) and phone number(s)

  • Date(s) of correspondence

  • Timeline of complaint event

• Gather and send all of the required documentation to the address provided by the PBM. Do not send originals, send copies of your personal supporting documentation.

• If you are unable to resolve your dispute with the company or aren’t satisfied with how they respond to your dispute, file a complaint with the Department. Please upload the information provided to the PBM and any additional information you feel will be beneficial in reviewing the dispute.

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