Terms Used In Montana Code > Title 33 > Chapter 2 > Part 24 - Pharmacy Benefit Manager Oversight

• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• 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. See Montana Code 33-2-2402

• 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.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Dependent: A person dependent for support upon another.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• distributor: has the meaning provided in 37-7-602. See Montana Code 33-2-2402
• 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
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Federally certified health entity: means a 340B covered entity as described in 42 U. See Montana Code 33-2-2402
• Health benefit plan: means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Montana Code 33-2-2402
• Health carrier: means an entity that is subject to the insurance laws and regulations of this state or to the jurisdiction of the commissioner and that contracts or offers to contract or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Montana Code 33-2-2402
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Knowingly: means only a knowledge that the facts exist which bring the act or omission within the provisions of this code. See Montana Code 1-1-204
• Manufacturer: has the meaning provided in 37-7-602. See Montana Code 33-2-2402
• Other prescription drug or device services: means services other than claims processing services that are provided directly or indirectly, whether in connection with or separate from claims processing services, including but not limited to:

  (a)negotiating rebates, discounts, or other financial incentives and arrangements with manufacturers, wholesale distributors, or other third parties;

  (b)disbursing or distributing rebates;

  (c)managing or participating in incentive programs or arrangements for pharmacist services;

  (d)negotiating or entering into contractual arrangements with pharmacists, pharmacies, or both;

  (e)developing and maintaining formularies;

  (f)designing prescription drug benefit programs;

  (g)advertising or promoting services; or

  (h)administering prior authorization, step therapy, case management, or other utilization review programs. See Montana Code 33-2-2402

• Oversight: Committee review of the activities of a Federal agency or program.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
• Pharmacist: has the meaning provided in 33-22-170. See Montana Code 33-2-2402
• Pharmacist services: means products, goods, and services or any combination of products, goods, and services provided as part of the practice of pharmacy. 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
• Plan sponsor: has the meaning provided in 33-10-202. 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
• Rebates: means all price concessions, however characterized, paid by a manufacturer to a pharmacy benefit manager, including discounts and other remuneration or price concessions, that are based on the actual or estimated utilization of a prescription drug. See Montana Code 33-2-2402
• 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
• Subpoena: A command to a witness to appear and give testimony.
• Writing: includes printing. See Montana Code 1-1-203