State Requirements

Applicant must not have an active resident state license on PDB in any state.

Pharmacy Benefits Manager, Pharmacy Services Administrative Organization, Third Party Administrator and Third Party Billing Service do not require Designated Responsible Licensed Producers (DRLP).

At least one Owner, Partner, Officer or Director must be provided on application.

Third Party Administrator .

Please ensure all required documents are submitted to the NIPR's Attachments Warehouse. A list of required documents for Third Party Administrators can be found at https://www.nj.gov/dobi/division_insurance/managedcare/tpa_application.pdf. 

Third Party Administrators may reinstate 31 days after expiration date.

Third Party Billing Service.

Please ensure all required documents are submitted to the NIPR's Attachments Warehouse. A list of required documents for Third Party Billing Service can be found at https://www.nj.gov/dobi/division_insurance/managedcare/tpa_application.pdf. 

Third Party Billing Service licenses are perpetual. An applicant may reinstate if the license is inactive.

After approval, please allow up to two business days to view and print your license.  Instructions may be found by clicking the state of New Hampshire on the license print page: http://www.nipr.com/map_producer_licensing.htm. 

• Pharmacy Benefits Manager must submit the following supplemental documentation to the NIPR Attachment Warehouse:
• The Application cover sheet.
• Provide a comprehensive description of the PBM, including its purpose and scope of services.
• Discuss entities with shared boards/management, their relationship to the PBM, and their activities.
• Detail the PBM's experience in managing pharmacy costs, including strategies and outcomes.
• Describe the PBM's methods and locations of operation.
• Include all relevant organizational documents (operating agreement, articles, partnership agreement, etc.).
• Attach governance documents like bylaws and internal rules.
• List names, addresses, and positions of key individuals; include ownership details and any legal actions.
• Provide parent company information if applicable, including ownership charts.
• Submit completed Biographical Affidavits.
• Describe the applicant, its facilities, personnel, and services offered.
• Include a copy of the standard agreement form with pharmacies.
• Attach the contract form with carriers, detailing compliance duties.
• Provide details for each contract, including key persons, affiliates, services, accessibility, and compensation.
• List all legal and regulatory actions involving the applicant or affiliates.
• Provide the total number of claims adjudicated in the previous calendar year.
• List contracted pharmacists/pharmacies and any affiliations.
• List manufacturer contracts, including ownership interests or affiliations.
• List rebate aggregator contracts, including ownership interests or affiliations.
• List switch company contracts, including ownership interests or affiliations.
• List wholesaler contracts, including ownership interests or affiliations.
• Provide a list of health benefits plan contracts, including services and enrollee numbers.
• Include the most recent year-end audited financial statements.
• Provide detailed financial projections for three years, with assumptions.
• Explain compensation methods, including administrative fees and spread pricing.
• Describe rebate usage, including pass-through and at-risk methods.
• List rebates paid to entities, with amounts reconciled to financial statements.

• Pharmacy Services Administrative Organization must submit the following supplemental documentation to the NIPR Attachment Warehouse:
• The Application cover sheet.
• Provide a description of the PSAO, including details on entities with shared boards/management and their relationships.
• Describe the PSAO's proposed methods and locations of operation, including significant procedures and programs.
• Include all relevant organizational documents (operating agreement, articles, charter, partnership agreement, etc.).
• Attach bylaws, rules, and regulations governing the registrant’s internal affairs.
• List names, addresses, and positions of key individuals; include ownership details and any legal actions.
• Submit completed Biographical Affidavits.
• Provide parent company information if applicable, including ownership charts.
• Include the most recent year-end audited financial statements.
• Explain in detail how the registrant is compensated for its services.

If applicant responds "yes" to one of the background questions please submit supporting documents electronically via NIPR's Attachments Warehouse. The documents may also be submitted to the state via mail, email, or fax.