DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES  
INSURANCE  
PHARMACY BENEFIT MANAGER LICENSURE AND REGULATION  
(By authority conferred on the director of the department of insurance and financial  
services by sections 11 and 13 of the pharmacy benefit manager licensure and regulation  
act, 2022 PA 11, MCL 550.821 and 550.823)  
R 500.31 Definitions.  
Rule 1. (1) As used in these rules:  
“Act” means the pharmacy benefit manager licensure and regulation act, 2022 PA 11,  
MCL 550.811 to 550.845.  
(2) A term defined in the act has the same meaning when used in these rules.  
History: 2023 MR 24, Eff. Jan 2, 2024.  
R 500.32 Scope and applicability.  
Rule 2. These rules establish all of the following:  
(a) The application contents and fee.  
(b) The license renewal schedule and renewal fee.  
(c) Standards regarding fines and suspension, a restriction, and revocation of a  
license.  
History: 2023 MR 24, Eff. Jan 2, 2024.  
R 500.33 Application contents and fee; supplemental documents.  
Rule 3. (1) To obtain a license, an applicant shall submit the following:  
(a) An application on a form provided by the director.  
(b) The supplemental documents required under section 11(2) of the act, MCL  
550.821, and this rule.  
(c) A nonrefundable application fee in an amount established by the director by  
bulletin. The director shall not adjust the application fee more than once per year.  
(2) An applicant shall provide the following supplemental documents with an  
application submitted under subrule (1) of this rule:  
(a) The documents required under section 11(2) of the act, MCL 550.821.  
(b) A document providing the names, addresses, dates of birth, social security  
numbers, official positions, and professional qualifications of each individual who owns,  
legally or beneficially, 10% or more of the equity in the entity that is applying for a license.  
(c) Each of the following:  
(i) A list of every health plan or carrier on behalf of which the pharmacy benefit  
manager contracts with a pharmacy or a pharmacy services administration organization to  
provide pharmacy health services to individuals covered by the health plan or carrier.  
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(ii) A statement indicating all jurisdictions where the applicant has an application  
pending or has been registered, licensed, or otherwise certified to transact business as a  
pharmacy benefit manager.  
(iii) A statement indicating whether:  
(A) The pharmacy benefit manager or any individual responsible for the conduct of  
the affairs of the pharmacy benefit manager has had a pharmacy benefit manager certificate  
of authority or license denied or revoked for cause in another state.  
(B) Any individual responsible for the conduct of the affairs of the pharmacy benefit  
manager has been convicted of, or has entered a plea of guilty or nolo contendere to, a  
felony without regard to whether adjudication was withheld.  
(C) The pharmacy benefit manager’s license has been suspended or revoked in  
another state.  
(3) Any modification to the information required under subrule (2)(b) and (c) of this  
rule is significant, and, under section 11(3) of the act, MCL 550.821, the applicant shall  
file with the director a notice of modification to any information within 30 days after the  
modification.  
History: 2023 MR 24, Eff. Jan 2, 2024.  
R 500.34 License renewal schedule; license renewal fee.  
Rule 4. (1) To renew an existing license for an additional 2 years, a pharmacy benefit  
manager shall file the materials required under this rule and section 11(10) of the act, MCL  
550.821, no later than July 1 of the second calendar year after the calendar year in which  
the pharmacy benefit manager either first obtained or last renewed the existing license.  
(2) A license expires if the pharmacy benefit manager fails to submit a complete  
renewal filing by the date established in subrule (1) of this rule. If a license expires under  
this subrule, the pharmacy benefit manager shall not operate in this state as a pharmacy  
benefit manager without first obtaining a new license through the process in R 500.33. On  
request and for good cause shown, the director may grant to a pharmacy benefit manager  
a reasonable extension of time not to exceed 30 days within which the renewal materials  
must be filed.  
(3) A renewal filing is incomplete if the director determines that it does not contain a  
completed application and renewal schedule and full payment of the nonrefundable license  
renewal fee that is established by the director.  
(4) A renewal application or a renewal schedule is not complete unless the licensee  
fully and accurately provides all the information and materials requested on any form  
provided by the director. The director has discretion to revise any form that the director  
provides under this subdivision.  
(5) The director may establish the amount of the nonrefundable license renewal fee  
by bulletin. The director shall not adjust the license renewal fee more than once per year.  
(6) A renewal filing is incomplete if the director determines that the renewal filing  
does not contain a retail pharmacy benefit manager network adequacy report, as required  
under section 17 of the act, MCL 550.827.  
History: 2023 MR 24, Eff. Jan 2, 2024.  
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R 500.35 Suspension, revocation, and restriction of licensure; fines.  
Rule 5. (1) The director may suspend the license of a pharmacy benefit manager as  
provided in sections 11(5) and (6) of the act, MCL 550.821. A pharmacy benefit manager  
whose license is suspended shall not operate within this state as a pharmacy benefit  
manager during the suspension.  
(2) The director may revoke the license of a pharmacy benefit manager as provided  
in section 11(5) or (7) of the act, MCL 550.821. A pharmacy benefit manager whose license  
is revoked shall not operate within this state as a pharmacy benefit manager as of the date  
specified in the director’s order.  
(3) The director may restrict the license of a pharmacy benefit manager under the  
authority of section 13 of the act, MCL 550.823. An order of the director to suspend or to  
restrict a license takes effect immediately, unless the order explicitly states otherwise. If a  
director’s order suspending or restricting a license explicitly allows the pharmacy benefit  
manager to operate after the order is issued, the affected pharmacy benefit manager shall  
operate for the period specified in the order and according to the conditions set forth in the  
order.  
(4) When the director orders the suspension or revocation of a license under the act,  
the director has discretion to issue an order adapted to the underlying violation by requiring  
the pharmacy benefit manager to pay a fine or otherwise restricting the pharmacy benefit  
manager’s license.  
(5) A pharmacy benefit manager whose license has been suspended or restricted under  
the act and these rules shall pay the fine specified in the order mandating the suspension or  
restriction. If the director’s order mandates a monthly fine until the underlying violation is  
remedied, the affected pharmacy benefit manager shall pay the specified fine each month  
until the pharmacy benefit manager demonstrates to the director, in a manner specified in  
the director’s order, that the pharmacy benefit manager has remedied the violation leading  
to the suspension or restriction. If the director’s order mandates any fine other than a  
monthly fine, the affected pharmacy benefit manager shall pay the fine specified in the  
order and comply with all other conditions set forth in the order.  
History: 2023 MR 24, Eff. Jan 2, 2024.  
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