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 PBM Complaint form (File A PBM Complaint) in its entirety and attach any denied appeal documents, if available.
- If you have multiple complaints with the same PBM and the same type of issues, skip question number 3 and
- Provide question 3.a-e information on a spreadsheet for each Covered Individual (CI).
- Provide a completed and signed PBM Complaint form with the Spreadsheet.
Note:
- Unanswered questions and/or unsigned complaint forms could cause delays in processing.
- Review your PBM Regulation Key Points brochure to provide the Statute(s) or Rule(s) in question. To request a copy of the brochure, call Consumer Services Division at 334-241-4141.
WHAT WE CAN AND CANNOT DO
WE CAN...
- Submit your complaint to the PBM and require a response 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.
WE CANNOT...
- Assist with your PBM complaint if the transaction in question occurred prior to October 1, 2021.
- Assist with your PBM complaint if you have involved an attorney.
- Provide legal advice or provide legal representation.
- Intervene on your behalf in a pending lawsuit.
- Provide medical advice.
- Determine the facts regarding any other disagreement between you and another party.
- Help resolve PBM complaints or investigate matters that are not subject to the laws of the State of Alabama.