33-22-170. Definitions. As used in 33-22-170 through 33-22-177 and 33-22-180, the following definitions apply:
(1) "Contract pharmacy" means a pharmacy operating under contract with a federally certified health entity to provide dispensing services to the federally certified health entity.
(2) "Federally certified health entity" means a 340B covered entity as described in 42 U.S.C. 256b(a)(4).
(3) "Maximum allowable cost list" means the list of drugs used by a pharmacy benefit manager that sets the maximum cost on which reimbursement to a network pharmacy or pharmacist is based.
(4) "Pharmacist" means a person licensed by the state to engage in the practice of pharmacy pursuant to Title 37, chapter 7.
(5) "Pharmacy" means an established location, either physical or electronic, that is licensed by the board of pharmacy pursuant to Title 37, chapter 7, and that has entered into a network contract with a pharmacy benefit manager, health insurance issuer, or plan sponsor.
(6) "Pharmacy benefit manager" means a person who contracts with pharmacies on behalf of a health insurance issuer, third-party administrator, or plan sponsor to process claims for prescription drugs, provide retail network management for pharmacies or pharmacists, pay pharmacies or pharmacists for prescription drugs, or provide other prescription drug or device services.
(7) "Pharmacy performance measurement entity" means:
(a) the electronic quality improvement platform for plans and pharmacies; or
(b) an entity approved by the board of pharmacy provided for in 2-15-1733 as a nationally recognized and unbiased entity that assists pharmacies in improving performance measures.
(8) "Prescription drug" means any drug that is required by federal law or regulation to be dispensed only by a prescription subject to section 353(b) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 301 et seq.
(9) "Prescription drug order" has the meaning provided in 37-7-101.
(10) "Reference pricing" means a calculation for the price of a pharmaceutical that uses the most current nationally recognized reference price or amount to set the reimbursement for prescription drugs and other products, supplies, and services covered by a network contract between a plan sponsor, health insurance issuer, or pharmacy benefit manager and a pharmacy or pharmacist.
History: En. Sec. 1, Ch. 431, L. 2015; amd. Sec. 1, Ch. 136, L. 2017; amd. Sec. 5, Ch. 88, L. 2019; amd. Sec. 3, Ch. 215, L. 2019; amd. Sec. 15, Ch. 501, L. 2021.
Structure Montana Code Annotated
Title 33. Insurance and Insurance Companies
Chapter 22. Disability Insurance
33-22-101. Exceptions to scope
33-22-102. Third-party ownership
33-22-104. through 33-22-106 reserved
33-22-107. Premium increase restriction -- exception -- notice of rate increase and policy changes
33-22-110. Preexisting conditions
33-22-113. Disability insurance coverage of persons eligible for public medical assistance
33-22-116. Prohibition on coverage of abortion services in qualified health plans
33-22-118. through 33-22-120 reserved
33-22-121. Notice required for cancellation or refusal to renew
33-22-122. Contents of notice -- proof -- limitation on recovery -- exemptions
33-22-123. Return of unearned premium
33-22-125. Independent chiropractic physical examination or review of records
33-22-126. and 33-22-127 reserved
33-22-128. Coverage for children with hearing loss -- definitions
33-22-130. Coverage for adopted children from time of placement -- preexisting conditions
33-22-131. Coverage for treatment of inborn errors of metabolism
33-22-132. Coverage for mammography examinations
33-22-133. Coverage for minimum hospital stay following childbirth
33-22-134. Postmastectomy care
33-22-135. Coverage for reconstructive breast surgery after mastectomy -- benefits and conditions
33-22-137. Cost-sharing requirements -- applicability
33-22-138. Coverage for telehealth services -- rulemaking
33-22-139. Coverage of therapies for Down syndrome
33-22-141. Crediting previous coverage
33-22-142. Certification of creditable coverage
33-22-144. through 33-22-149 reserved
33-22-152. Continuation of dependent coverage
33-22-154. and 33-22-155 reserved
33-22-156. Health insurance rates -- filing required -- use
33-22-157. Standards for review -- notice of deficiency
33-22-158. Trade secret disclosure exemption
33-22-160. through 33-22-165 reserved
33-22-167. through 33-22-169 reserved
33-22-171. Maximum allowable cost list -- limitations on drugs
33-22-173. Maximum allowable cost -- appeals process
33-22-174. Opt-out of reference pricing -- notification
33-22-175. Allowable and prohibited fees on pharmacies
33-22-176. Limitation on copayments
33-22-177. Rights of pharmacies
33-22-178. and 33-22-179 reserved
33-22-180. Contract coverage -- nondiscrimination -- penalty