Rule 120-2-97-.03. License; application; issuance; renewal; net worth; probationary license

1. (1) It is unlawful for any person, business entity, or other entity to act as or hold itself out to be a pharmacy benefits manager in this State without a valid license issued by the Commissioner of Insurance. To qualify for and hold a license to act as a pharmacy benefits manager in this State, a pharmacy benefits manager must otherwise be in compliance with Chapter 64 of Title 33 of the Official Code of Georgia Annotated and this Regulation.
2. (2) The pharmacy benefits manager shall file with the Commissioner an application for a license upon a form to be furnished by the Commissioner.
3. (3) An audited financial statement or such other information as the Commissioner may require that demonstrates that the applicant possesses a minimum net worth of $200,000. Letters of credit, backstop guarantees and special corporate structures will not be taken into consideration by the Commissioner in determining the net worth requirement.
4. (4) A Bond and proof of Errors and Omissions coverage must be included in the application and maintained by the pharmacy benefits manager.
5. (5) An application for a pharmacy benefits manager's license shall be accompanied by a fee of $2000.00.

6. (6) The Commissioner shall not issue a license or renew an existing license if he or she determines that the pharmacy benefits manager has:

   1. (a) Misrepresented or concealed any material fact in the application for the license;
   2. (b) Has obtained or attempted to obtain the license by misrepresentation, concealment, or other fraud;
   3. (c) Has committed fraud;
   4. (d) Has failed to obtain for initial licensure or retain for annual renewal a net worth of at least $200,000; or
   5. (e) Has violated any provision of this chapter while on probation, if for license renewal.
7. (7) A license issued under this section may be issued on a probationary basis in the discretion of the Commissioner. The probationary license may be issued for not longer than 12 months and not less than 3 months and is subject to revocation without a hearing. The Commissioner, at his or her discretion, shall prescribe the terms of probation, may extend the probationary period, or refuse to grant a license at the end of any probationary period.

Authority: O.C.G.A. §§ 33-2-9, 33-64-7.

History. Original Rule entitled "License; Application; Issuance; Renewal; Net Worth; Probationary License" adopted. F. March 16, 2011; eff. April 5, 2011.

Repealed: New Rule with same titled adopted. F. Dec. 7, 2020; eff. Jan. 1, 2021, as specified by the Agency.