PHARMACY BENEFIT MANAGERS

csimt Insurance

LICENSING REQUIREMENT

The “Montana Pharmacy Benefit Manager Oversight Act” was enacted by the 2021 Montana Legislature. Effective January 1, 2022, a Pharmacy Benefit Manager (PBM) must be licensed to operate within the State of Montana. PBM licenses must be renewed annually. Click HERE to read the law.

NEW APPLICANTS

  1. Download the completed PBM Licensing Application/Renewal Form.
  2. Upload the PBM application and the following required materials in the upload section at the bottom of this page.

Required Materials

    • Proof of registration with the Montana Secretary of State’s office.
    • A copy of the most recent fiscal year-end audited financial statement of the PBM.
    • 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.
    • 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 pharmacy network.
    • 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 PBM or by the PBM in a health carrier or workers’ compensation insurance carrier.
    • An NAIC biographical affidavit for each person listed in question 15 of the application.
    • Network Adequacy—PBMs must 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. Applicants must also submit the following documents for each network as part of their license or license renewal application:

PAYMENT INFORMATION

Please pay the application fee of $1,000.

By paying electronically via Automated Clearing House (ACH). To request ACH information, please fill out and upload the ACH Request Form and upload it with your other materials.

or

By mailing 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.

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.

Click or drag files to this area to upload. You can upload up to 25 files.