Before you file a PBM request for assistance with the Alabama Department of Insurance,
you should first contact the Pharmacy Benefit Management Company (PBM) or the insurance company to
resolve the issue(s) through their Appeals Process.
If you do not receive a satisfactory response, then download the PBM Complaint form (Request for Assistance) and spreadsheet.
PBM Complaint Form
Instructions to File a PBM Complaint
IF YOU ARE, A PHARMACY OR PHARMACIST FILING A COMPLAINT AGAINST A PHARMACY BENEFITS MANAGER (PBM):
- Fill out the complaint form in its entirety unless you have multiple insureds with the same type complaint.
In this case, skip question number 3 of the complaint form.
- Provide question 3.a-e information on a spreadsheet when there are multiple files of the same
type/reason being filed.
- Each Complaint type, e.g., Steering, Willing Provider, Gag Rule, and Fees, etc., must be filed with separate PBM Complaint forms
and a separate Spread Sheet.
- Submit your complaint to the PBM (Pharmacy Benefit Manager). They are required to respond to the Alabama Department of Insurance.
- Review the response to determine if the PBM is acting according to Title 27, Section 45A as revised by Act 2021-341 (the Act).
- Require corrective action, if we determine that the PBM or Insurance Company did not meet the legal requirements of the Act.
- Assist with your PBM complaint if the transaction in question occurred prior to October 1, 2021.
- Assist you with your PBM complaint if you have an attorney.
- Provide legal advice or provide legal representation.
- Intervene on your behalf in a pending lawsuit.
- Determine the value of a claim or the amount of money owed to you.
- Determine the facts regarding any other disagreement between you and another party.
- Help resolve PBM complaints or investigate matters for plans that are not subject to the laws of the State of Alabama.
Note: If you have a self-funded plan that is governed by the federal Employee Retirement Income Security Act (ERISA), your employer or a TPA chosen by your Employer administers the program. You will
need to contact your employer for assistance.
There may be portions of Title 27, Section 45A that do not apply to Self-Funded ERISA Plans.