In Review: PBMs licensed in Florida recently received a data request from the Office of Insurance Regulation (OIR) as part of their market conduct exams. The data requested includes a list of all plan contracts executed, amended, adjusted, or renewed on or after July 1, 2023, a list of all participation contracts, a list of in and out-of-network claims closed with and without payment, detailed claims data for all types of plans, and a list of all prescription drug benefit appeals evaluated by the PBM. In addition to the concerns raised by the data request, some members have expressed concern regarding the estimated costs of the market conduct exams.

Up Next: PCMA will be working to obtain letters of representation in order to meet with OIR and discuss details of the market conduct exams.

If you have any questions, please contact Connor Rose at crose@pcmanet.org.