• Pharmacy Benefits Manager -
    File a Complaint

This form is ONLY for pharmacies submitting a complaint against a Pharmacy Benefits Manager (PBM).

  • If you are an individual covered by a commercial health plan, please submit a complaint with the OSI Managed Health Bureau here: MHCB Complaint Form.
  • For Medicaid complaints, submit a complaint via the Grievance Intake Form.
  • For Medicare complaints, submit a complaint via the Medicare Complaint Form.
  • For governmental or group self-insured members, please contact your employer for more information.
Thank you.

Complainant:

Pharmacy Contact Name
Pharmacy Address
Pharmacy Email

PBM:

PBM Contact Name
PBM Address

Type of Issue

Please describe the issue in detail. Please include reference to the statute or rule the PBM allegedly violated. For reference, the Pharmacy Benefit Manager Regulation Act is at Section 59A-61-1, et seq., NMSA 1978 and the corresponding rule is 13.10.30 NMAC. Complaints shall be based on a rule or statute enforced by the New Mexico Office of the Superintendent of Insurance.
Click or drag files to this area to upload. You can upload up to 10 files.
Please attach any documents relevant to your complaint:
The information contained within is confidential and shall not be disclosed or other provided to anyone not a party to the complaint except the Office of Superintendent of Insurance.

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