Montana § 33-22-175 - Allowable And Prohibited Fees On Pharmacies

§ 33-22-175. Allowable And Prohibited Fees On Pharmacies

(Temporary) Allowable and prohibited fees on pharmacies. (1) A pharmacy benefit manager, a third-party payer, or a discount card processor may not directly or indirectly charge or hold a pharmacy responsible for a fee, including but not limited to the following: (a) a fee for submission of a claim; (b) any other claim-related fee; (c) a fee for enrollment or participation in a retail pharmacy network; (d) a credentialing or recredentialing fee; (e) a fee for the development or management of claims processing services or claims payment services; or (f) a fee on remittance advice or a fee that is retroactive. (2) Only criteria established by a pharmacy performance measurement entity may be used to measure a pharmacy's performance for the purposes of this section. (3) A pharmacy benefits manager or third-party payer may not make or allow any reduction in payment for pharmacy services by a pharmacy benefits manager or third-party payer or directly or indirectly reduce a payment for a pharmacy service under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payments. (4) All reimbursements to pharmacies must be made through direct bank transfers, checks, or other payment methods that do not incur processing fees for the pharmacy. Checks must have a 180-day expiration to deposit. (Terminates June 30, 2029--sec. 8, Ch. 474, L. 2025.) 33-22-175 . (Effective July 1, 2029) 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.