SECTION 365:25-29-14. Inquiry/complaint handling process

Latest version.

(a)   Complaints alleging failure by the PBM to comply with the act, shall be made in writing to the Commissioner, supported by evidentiary materials. All complaints must include a completed "PBM Complaint Form" as promulgated by the Commissioner.
(b)   All audits of PBMs by health insurers shall include a review of complaints against the PBM to determine compliance with the terms of the contract between the PBM and the complainant.
(c)   PBMs must provide the complainant with a written notice as to the final disposition of the complaint.
(d)   As part of its response to the Department in connection with every complaint, the PBM must provide a statement to the Department that the complaint was carefully reviewed and could not be resolved under the terms and conditions of the contract.

[Source: Added at 37 Ok Reg 135, eff 11-1-19 (emergency); Added at 37 Ok Reg 1926, eff 9-11-20]

                    
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