33-2-2403. Licensing required. (1) A person may not perform an act or do business in this state as a pharmacy benefit manager without a valid license issued under this part by the commissioner.
(2) A license issued under this part is nontransferable.
(3) A pharmacy benefit manager shall apply to the commissioner on a form prescribed by the commissioner. At a minimum, the application form must include the following information:
(a) the name, business address, and telephone number of the pharmacy benefit manager and the name, address, and contact information for the principal contact person of the pharmacy benefit manager for communications with the commissioner on licensure-related matters;
(b) the name and address of:
(i) all members of the pharmacy benefit manager's board of directors, board of trustees, executive committee, or other governing board of committee;
(ii) the principal officers in the case of a corporation; or
(iii) the partners or members in the case of a partnership or association;
(c) proof of registration with the Montana secretary of state;
(d) a copy of the most recent fiscal yearend audited financial statement of the pharmacy benefit manager;
(e) a list of all health carrier, plan sponsor, and workers' compensation insurance carrier clients in this state;
(f) a description of the projected number of enrollees and injured workers to be administered by the pharmacy benefit manager in this state on an annual basis for each health carrier client, plan sponsor client, and workers' compensation insurance carrier client;
(g) a copy of the policies and procedures that demonstrate the pharmacy benefit manager has established processes to comply with the requirements of 33-22-170 through 33-22-177 and 33-22-180 concerning maximum allowable costs lists, including the appeals process required under 33-22-173;
(h) a description of the pharmacy benefit manager's network service areas and pharmacy accessibility in this state;
(i) 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 pharmacy benefit manager's network; and
(j) disclosure of any ownership interest, either directly or indirectly or through an affiliate, holding company, or subsidiary by a health carrier or workers' compensation insurance carrier in the pharmacy benefit manager or by the pharmacy benefit manager in a health carrier or workers' compensation insurance carrier.
(4) Each application for licensure must be accompanied by a nonrefundable fee of $1,000.
(5) The commissioner may require additional information for submission from an applicant and may obtain any document or information reasonably necessary to verify the information contained in an application.
(6) The commissioner may refuse to issue or renew a license if the commissioner finds that the applicant:
(a) is not competent, trustworthy, or financially responsible;
(b) has violated the insurance laws of this state, including violation of 33-22-170 through 33-22-177 and 33-22-180, or any other state; or
(c) has had an insurance or other certificate of authority or license denied or revoked for cause by any jurisdiction.
(7) The commissioner shall grant or deny an initial application for a license within 60 days from the date that a completed application and license fee is received.
(8) (a) Unless surrendered, suspended, or revoked by the commissioner, a license issued under this section is valid as long as the pharmacy benefit manager:
(i) continues to do business in this state;
(ii) remains in compliance with the provisions of this part;
(iii) completes a renewal application on a form prescribed by the commissioner; and
(iv) pays an annual license renewal fee of $500.
(b) The renewal fee and application must be received by the commissioner at least 30 days before the anniversary of the effective date of the pharmacy benefit manager's initial or most recent license.
(9) Denial of an application for initial licensure or renewal of licensure is considered a contested case under the Montana Administrative Procedure Act.
(10) In lieu of denying an application for initial licensure or renewal of licensure, the commissioner may allow the pharmacy benefit manager to submit a corrective action plan to cure or correct the deficiencies identified in review of the application.
History: En. Sec. 3, Ch. 501, L. 2021.