What are Pharmacy Benefit Managers?
Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits. PBMs are intermediaries that operate between your health insurance company, which the PBM works for, and the pharmacy, where you fill a prescription. The PBM reimburses the pharmacy for dispensing the prescription.
- See a list of Pharmacy Benefit Managers Licensed in New York.
- To learn more about how the Department licenses PBMs, visit our PBM Licensing page.
File a Complaint About a PBM
Consumers and pharmacies can be connected with PBMs to resolve problems. DFS sends complaints that we receive about PBMs to those PBMs for a response. If another agency can help you, we will let you know.
- Consumers can create a DFS account or file a PBM complaint at https://dfsconnect.dfs.ny.gov/complaint.
- Entities can create or log into their DFS Connect accounts at https://dfsconnect.dfs.ny.gov.
DFS has created user guides to assist consumers using DFS Connect:
- For help creating a DFS Connect account, read the Accessing DFS Connect as a Consumer user guide.
- For help using DFS Connect to submit a complaint about a PBM, read the Using DFS Connect to Submit a Complaint About a PBM (PDF) user guide.
- For help accepting or asking DFS to review a complaint against a PBM, read the Accepting or Appealing a PBM Response to a Complaint in DFS Connect User Guide (PDF)
What You Will Need to Submit
Save all communications you have with the PBM. Gather the information and documents that you will submit with your complaint.
You must provide the following as part of your complaint:
- Your full name, email, and address
- The name of the PBM
- The name of the health insurance company
- The pharmacy name and address
- A description with as much detail as possible about the reason for your complaint
- Copies of any communications you have had with the PBM
- Pharmacies must also provide the pharmacy NCPDP
You do not need to be represented by an attorney to file a complaint. However, the Department cannot act as your attorney or give you legal advice, recommend a health insurance company, PBM, or pharmacy, or provide medical advice.
Complaints About Significant Price Increases for Prescription Drugs
If you are experiencing a dramatic increase in the cost of a prescription drug, you can Report a Drug Price Increase to the Department via DFS Connect.
Printable Complaint Forms
You are strongly encouraged to submit your PBM Complaint online using DFS Connect. This will avoid delay in the handling of a paper complaint. If you must use a paper complaint, they are available on our Consumer Complaint page, and can be mailed to the Department of Financial Services, Attn: Office of Pharmacy Benefits, 1 Commerce Plaza, Albany, NY 12257.
Complaints About Health Insurance Companies
If you are having a problem with a health insurance company, you should file a Consumer Complaint with the Department.