STATE OF WEST VIRGINIA
Offices of the Insurance Commissioner
James A. Dodrill
Insurance Commissioner
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Pharmacy Benefit Manager Pre-License Form

West Virginia Senate Bill 489 was signed into law on March 1, 2019. This bill requires pharmacy benefit managers which contract to administer prescription drug benefits on behalf of a health insurer or health maintenance organization to residents of West Virginia to obtain a license with the West Virginia Offices of the Insurance Commissioner (WVOIC).

All pharmacy benefit managers must provide pre-license information using the form below.  The information you provide in this form will be used to distribute additional information at a later date once the application to obtain the license process has been finalized.   Please contact the WVOIC at OICPBM@wv.gov or 304-558-6279 ext. 1119 with any questions regarding this pre-license form or if you need to update your information such as contact name, phone or email changes, or any other information required as a part of this form. 

Pharmacy Benefit Manager Pre-License Form