Montana Code 33-2-2410. Federal 340B drug pricing program
33-2-2410. Federal 340B drug pricing program. A pharmacy benefit manager or health carrier may not:
Terms Used In Montana Code 33-2-2410
- Contract: A legal written agreement that becomes binding when signed.
- Federally certified health entity: means a 340B covered entity as described in 42 U. 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
- 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
(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 with an entity differently than it reimburses other similarly situated pharmacies;
(3)require a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the medicaid program provided for in Title 53, chapter 6, part 1; or
(4)create a restriction or an additional charge on a patient who chooses to receive drugs from a federally certified health entity or a pharmacy under contract with an entity, including but not limited to a patient’s inability to fully pay a copayment. (Subsection (3) terminates June 1, 2025–sec. 1, Ch. 259, L. 2023.)