The Massachusetts Pharmacy Benefit Manager license
Pharmacy Benefit Manager
Runs the drug benefit for a health plan, and since 2026 cannot do it in Massachusetts without a license from the Division. At twenty-five thousand dollars to apply and the same to renew, it costs more than forty times what Massachusetts charges to register a service contract provider, which is the next dearest thing the Division licenses.
Course
None
This license has no pre-licensing course route.
Ways in
1
There is no state exam for this license.
Exam
n/a
Not required on any of the routes below.
Every way to qualify
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Route 1 Apply to the Division
No state exam for this license
What the Division has to be satisfied of
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That the entity possesses the necessary organization, background expertise and financial integrity to supply the services it means to offer. That is the whole of the competence finding and it carries no number, no examination and no course.
and what goes in the application
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The name, address and telephone number of the applicant, the name and address of its agent for service of process in the commonwealth, the name and address of every person with management or control over it, and audited financial statements specific to it. A material change to any of that is reported within 30 days, certified by an officer.
and the fee
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Twenty-five thousand dollars to apply and twenty-five thousand dollars to renew, on a three-year license that is not transferable and carries no rights that are.
G.L. c. 176Y section 2, enacted by chapter 342 of the Acts of 2024. The section makes operating without the license an offence priced by the day, $5,000 for every day the entity is found in violation, and a further $5,000 minimum for each violation of the chapter. The Division may issue or renew subject to restrictions on the services offered or the activities engaged in, which is a conditional license nothing else here provides for. The Division has staged the scheme rather than starting it at the statutory term: bulletin 2025-04 required every pharmacy benefit manager operating here to hold an initial one-year license by 1 January 2026 on applications due 15 October 2025, those licenses all expire on 31 December 2026, and the next period is the three-year one from 1 January 2027 to 31 December 2029 under 211 CMR 157.00 and filing guidance notice 2026-H. A licensee also submits data to the Center for Health Information and Analysis under G.L. c. 12C section 10A, and must tell a carrier client in writing about any arrangement that presents a conflict of interest.
Read at malegislature.gov on 2026-08-19
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No national seller sells a course for this license, and nothing could. G.L. c. 176Y section 2 grants the license on the Division being satisfied of an entity's organization, expertise and financial integrity, and on $25,000. There is no examination and no course.