Instructions & Form
The Utah Pharmacy Benefit Manager Report is a required state-specific annual filing. The purpose of this filing is to meet the requirements of Utah Code § 31A-46-301 and Administrative Code R590-282.
Who is required to file?
As required by Utah Code § 31A-46-301 and Administrative Code R590-282, every licensed Pharmacy Benefit Manager operating in the State of Utah is required to complete and file this annual report. The completed report is due April 1, 2023. Failure to file by the deadline may subject your company to the enforcement penalties under Utah Code § 31A-2-308.
Status of the report for data year 2022
The Utah Pharmacy Benefit Manager Report is now available for the 2022 data year. Please review the instructions and survey forms carefully so that you will understand how to report your data. This will save time and reduce the number of corrections after the report form is filed. However, we will work with you to understand and file the report form.
The Utah Insurance Department will only accept electronic submissions of the Utah Pharmacy Benefit Manager Report as an Excel spreadsheet via the UID secure file upload website at https://forms.uid.utah.gov/fileUploads/. All survey files should be uploaded to the “Health Research” folder. Do not use another folder to submit your files.
Any other forms of data submission are not acceptable. Also, do not make any changes to the formatting of the Excel report form. This file is designed to allow us to import your data directly into a software database, while attempting to remain “user-friendly”. Any changes to the line numbers, columns, or other parts of the report form (other than simple data entry) may cause errors when we import your report form.
Please remember each licensed Pharmacy Benefit Manager is required to file a complete report form. In cases where your company has nothing to report, answer with a “0” rather than leaving a section blank. To make this easier, we have pre-populated the survey with sample data, so that you can change just the sections that are applicable to your company. This includes providing a contact person, with correct contact information, including a valid telephone number and email address.
Please note that all data in the report form should be whole numbers. Use of decimals creates rounding errors when the data is processed.
Also, please only submit one company per Excel form. Filings with multiple companies in multiple Excel sheets will not import correctly.
How to get the forms
Please download the instructions, the signature form, and the report form using the links available below. Right-click on each link and select “Save Target As” to download each file to your computer.
The report instructions and signature form are available in Adobe PDF format. The report form is available as a data entry form in Microsoft Excel format.
Companies are expected to read the instructions before completing the form. Questions regarding the Utah Pharmacy Benefit Manager Report should be directed to the Research Assistant at email@example.com.
- PBM Report Instructions in Adobe PDF format
- PBM Signature Form in Adobe PDF format
(Please note that the Signature Form should be submitted along with the PBM Report Form.)
- PBM Report Form in Microsoft Excel format