Montana Code 33-2-2408. Pharmacy benefit manager appeals report
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:
Terms Used In Montana Code 33-2-2408
- Pharmacy: means an established location, either physical or electronic, that is licensed by the board of pharmacy pursuant to Title 37, chapter 7. See Montana Code 33-2-2402
- Pharmacy benefit manager: means a person, including a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager, that provides claims processing services or other prescription drug or device services, or both, to:
(i)enrollees who are residents of this state, for health benefit plans; or
(ii)injured workers of workers' compensation insurance carriers. See Montana Code 33-2-2402
- Writing: includes printing. See Montana Code 1-1-203
(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 the denials;
(c)for each denial, confirmation that the pharmacy benefit manager provided the pharmacy in writing the pricing and other information required under 33-22-173;
(d)the total amount of price adjustments made by the pharmacy benefit manager; and
(e)the average amount of days taken to make price adjustments.
(2)The report must be filed within 30 days of the close of each calendar quarter.
(3)The commissioner may request information required under this section at any time if the commissioner believes the information is reasonably necessary to ensure compliance with this part, 33-22-170 through 33-22-177, and 33-22-180.