Montana Code 33-22-174. Opt-out of reference pricing — notification
33-22-174. Opt-out of reference pricing — notification. (1) A pharmacist or pharmacy in a network plan with a plan sponsor, health insurance issuer, or pharmacy benefit manager providing covered drugs on a reference pricing basis may decline to provide a brand-name drug, multisource generic drug, supply, or service if the reference pricing amount is less than the acquisition cost paid by the pharmacy or pharmacist.
Terms Used In Montana Code 33-22-174
- Health insurance issuer: means an insurer, a health service corporation, or a health maintenance organization. See Montana Code 33-22-140
- Network plan: means health insurance coverage offered by a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer. See Montana Code 33-22-140
- Plan sponsor: has the meaning provided under section 3(16)(B) of the Employee Retirement Income Security Act of 1974, 29 U. See Montana Code 33-22-140
(2)If a pharmacist or pharmacy declines to provide the prescription or service under the conditions in subsection (1), the pharmacy or pharmacist shall attempt to provide the customer with adequate information as to where the prescription for the drug, supply, or service may be filled.
(3)A pharmacy or pharmacist who declines to provide the prescription or service as provided in subsection (2) shall cooperate with any investigation and review of network adequacy.