Montana Code 33-2-2404. Pharmacy benefit manager prohibited practices
33-2-2404. Pharmacy benefit manager prohibited practices. (1) In any participation contracts between a pharmacy benefit manager and pharmacies, pharmacists, or pharmacy services administrative organizations, 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:
Terms Used In Montana Code 33-2-2404
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means a member, policyholder, subscriber, covered person, beneficiary, dependent, or other individual participating in a health benefit plan. See Montana Code 33-2-2402
- Pharmacist: has the meaning provided in 33-22-170. See Montana Code 33-2-2402
- 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
- Pharmacy services administrative organization: means an entity that acts as a contracting agent or provides contracting and other administrative services to pharmacies to assist them in their interactions with third-party payers and pharmacy benefit managers. See Montana Code 33-2-2402
- Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
(a)the decision of utilization reviewers or similar persons to authorize or deny drug coverage or benefits; and
(b)the process that is used to authorize or deny drug coverage or benefits.
(2)(a) A pharmacy benefit manager contract with a participating pharmacy, pharmacist, or a pharmacy services administrative organization in this state may not prohibit, restrict, or limit disclosure of information to the commissioner when the commissioner is investigating or examining a complaint or conducting a review of a pharmacy benefit manager’s compliance with the requirements of this part.
(b)A pharmacy benefit manager may not terminate the contract of or penalize a pharmacy, pharmacist, or a pharmacy services administrative organization for sharing any portion of the pharmacy benefit manager contract with the commissioner for investigation of a complaint or a question regarding whether the contract complies with this part.
(c)Any examination or review under this section must follow the examination procedures and requirements applicable to insurers under Title 33, chapter 1, part 4, including but not limited to the confidentiality provisions of 33-1-409.