33-2-2401. Short title — purpose. (1) This part may be cited as the “Montana Pharmacy Benefit Manager Oversight Act”. (2) This part establishes the standards and criteria for the licensure and regulation of pharmacy benefit managers that provide claims processing services or other prescription drug or device services for health benefit plans and workers’ compensation insurance carriers. […]
33-2-2402. Definitions. As used in this part, the following definitions apply: (1) ”Claims processing services” means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include either or both of the following: (a) receiving payments for pharmacist services; and (b) making payments to pharmacists or pharmacies. (2) ”Enrollee” means a member, […]
33-2-2403. Licensing required. (1) A person may not perform an act or do business in this state as a pharmacy benefit manager without a valid license issued under this part by the commissioner. (2) A license issued under this part is nontransferable. (3) A pharmacy benefit manager shall apply to the commissioner on a form prescribed by the […]
33-2-2404. Pharmacy benefit manager prohibited practices. (1) In any participation contracts between a pharmacy benefit manager and pharmacies or pharmacists providing prescription drug coverage, a pharmacy or pharmacist may not be prohibited, restricted, or penalized in any way from disclosing to any enrollee or injured worker any information the pharmacy or pharmacist considers appropriate regarding: (a) the […]
33-2-2405. Marketing and advertising. (1) A pharmacy benefit manager may not cause or knowingly permit the use of an advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading. (2) The commissioner may not review or approve a pharmacy benefit manager’s marketing or advertising documents prior to use by the pharmacy benefit manager. (3) The […]
33-2-2406. Pharmacy benefit manager transparency to carriers and plan sponsors. (1) Beginning in the second quarter after the effective date of a contract between a pharmacy benefit manager and a health carrier, plan sponsor, or workers’ compensation insurance carrier, the pharmacy benefit manager shall disclose, within 45 days of a request of the health carrier, plan […]
33-2-2407. Transparency report to the commissioner. (1) By July 1 each year for the immediately preceding calendar year, each pharmacy benefit manager doing business in this state shall report to the commissioner on a form prescribed by the commissioner the following information regarding prescription drug benefits provided to enrollees of each health carrier and plan sponsor […]
33-2-2408. Pharmacy benefit manager appeals report. (1) Pharmacy benefit managers shall track, monitor, and report to the commissioner each quarter the following aggregated information related to appeals filed pursuant to 33-22-173: (a) the number of appeals filed by pharmacies; (b) whether the appeals were denied or upheld by the pharmacy benefit manager and, if denied, the reasons for […]
33-2-2409. Network adequacy. (1) A pharmacy benefit manager shall provide an adequate and accessible pharmacy network for the provision of prescription drugs to ensure reasonable proximity of pharmacies to the businesses or personal residences of enrollees and injured workers. (2) In determining whether a pharmacy benefit manager has complied with the requirements of this section, consideration must […]
33-2-2410. Federal 340B drug pricing program. A pharmacy benefit manager or health carrier may not: (1) prohibit a federally certified health entity or a pharmacy under contract with an entity to provide pharmacy services from participating in the pharmacy benefit manager’s or health carrier’s provider network; (2) reimburse a federally certified health entity or a pharmacy under contract […]
33-2-2411. Enforcement — penalties. (1) The commissioner shall enforce the provisions of this part, 33-22-170 through 33-22-177, and 33-22-180 and may examine the affairs of a pharmacy benefit manager to determine compliance with the provisions. (2) Any examination under this section must follow the examination procedures and requirements applicable to insurers under Title 33, chapter 1, part […]
33-2-2412. Rulemaking. The commissioner may adopt rules as necessary to implement the provisions of this part. History: En. Sec. 12, Ch. 501, L. 2021.
