33-22-175. Allowable and prohibited fees on pharmacies. (1) A pharmacy benefit manager or third-party payer may not directly or indirectly charge or hold a pharmacy responsible for a fee related to a claim:
(a) if the fee is not apparent at the time the claim is processed;
(b) if the fee is not reported on the remittance advice of an adjudicated claim; or
(c) after the initial claim is adjudicated.
(2) A pharmacy benefit manager or third-party payer may collect a performance-based fee from a pharmacy only if the pharmacy fails to meet the criteria established by a pharmacy performance measurement entity. The fee may be applied only to the professional dispensing fee outlined in the contract with the pharmacy and may not be imposed on the cost of goods sold by a pharmacy.
(3) Only criteria established by a pharmacy performance measurement entity may be used to measure a pharmacy's performance for the purposes of this section.
History: En. Sec. 1, Ch. 88, L. 2019.
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