LICENSING REQUIRMENT

The “Montana Pharmacy Benefit Manager Oversight Act” was enacted by the 2021 Montana Legislature. It requires that effective January 1, 2022, a Pharmacy Benefit Manager (PBM) must be licensed in order to operate within the state of Montana. Existing PBM licenses must be renewed annually. Click HERE to read the new law.

New applicants, please upload:

1. Complete the PBM Licensing Application/Renewal Form.
2. Pay the application/renewal fee of $1,000.
3. Upload the following documents:

• Proof of registration with the Montana Secretary of State’s office.
• The most recent fiscal year-end audited financial statement.
• A list of all health carrier, plan sponsor, and workers’ compensation insurance carrier clients in this state.
• A projection of the number of enrollees and injured workers to be administered by the PBM in this state on an annual basis for each health carrier client, plan sponsor client, and workers’ compensation insurance carrier client.
• A copy of the policies and procedures demonstrating the PBM has established processes to comply with §§ 33-22-170 through 33-22-177, MCA, and § 33-22-180, MCA, concerning maximum allowable costs lists, including the appeals process required under § 33-22-173, MCA.
• A list of the licensed pharmacies in the PBM network on a form prescribed by CSI.
• Disclosure of any ownership interest, either directly or indirectly or through an affiliate, holding company, or subsidiary, in a pharmacy or mail-order pharmacy that is part of the PBM’s network.
• Disclosure of any ownership interest, either directly or indirectly or through an affliate, holding company, or subsidiary, by a health carrier or workers’ compensation insurance carrier in the PBM or by the PBM in a health carrier or workers’ compensation insurance carrier.
• An NAIC biographical adavit or resume for every individual identied in response to application item #15.

NETWORK ADEQUACY

Under SB 395, pharmacy benefit managers shall provide an adequate and accessible pharmacy network for the provision of prescription drugs to ensure reasonable proximity of pharmacies to the businesses or personal residences of enrollees and injured workers under section 9.

Applicants will need to submit the following documents for each network as part of their license or license renewal application.

• Licensed Retail Pharmacies
• Accessibility Summary

Payment can be made by sending a check to: Montana Commissioner of Securities and Insurance 840 Helena Ave  I  Helena, MT 59601

Please include a cover letter that states the reason for payment, company name, and contact information that corresponds to the application information.

or

You can pay by Automated Clearing House (ACH).

Please note that most PBM’s are currently required to be licensed as Third-Party Administrators (TPAs) in the state of Montana. The new PBM licensing requirement does not replace the TPA licensing requirement. Most PBMs are required to hold both licenses on and after January 1, 2022.

Questions, please call Tavin Mogus at 406-444-3469 or email at tmogus@mt.gov  or Ramona Bidon at 406-444-4515 or rbidon@mt.gov.