Effective October 1, 2025, North Carolina updated resident and nonresident licensing rules requiring Pharmacy Benefits Managers (PBMs) to become licensed. 

• A person or organization must obtain a license to operate as a pharmacy benefits manager.
• To submit a complete application for initial or renewal PBM licensure, the following items must be filed in order:
•  A transmittal form;
• A completed pharmacy benefits application form;
• Biographical form(s) completed by principal officers;
• All of the PBM's organizational documents, including any articles of incorporation, articles of association, partnership agreement, trade name certificate, or trust agreement, any other applicable documents, and all amendments to these documents;
• The bylaws, rules, regulations, or similar documents regulating the PBM's internal affairs;
• Annual financial statements or reports for the two most recent years that prove that the applicant is solvent and any other information the Commissioner may require to review the applicant's current financial condition;
• A general description of the business operations, including information on staffing levels and activities proposed in North Carolina and nationwide;
• A power of attorney duly executed by the PBM, if not domiciled in North Carolina, appointing the Commissioner as attorney for the PBM in and for North Carolina, upon whom process in any legal action or proceeding against the PBM on a cause of action arising in North Carolina may be served; and
• Evidence of maintenance of a fidelity bond, errors and omissions liability insurance, or other security.
• The description discussed above must provide details setting forth the PBM's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing and record keeping.
• Each applicant must make copies of all contracts with insurers or other persons using the PBM's services available for inspection.
• An applicant or PBM must notify the Commissioner of any material modification within 30 business days of a change.

Pharmacy Benefit Manager

• Initial application fee: $2,000.00
• Annual renewal fee: $1,500.00

For more information on PBM licensing, visit NC DOI

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