Montana Title 33. Insurance and Insurance Companies § 33-22-173. Maximum allowable cost--appeals process

(1) In contracting with a pharmacy or a pharmacy services administrative organization, a plan sponsor or pharmacy benefit manager shall:

(2) If the final determination is a denial of the pharmacy's or the pharmacy services administrative organization's appeal, the pharmacy benefit manager shall state the reason for the denial and provide the national drug code of an equivalent drug that is available for purchase by pharmacies in this state from national or regional wholesalers at a price that is equal to or less than the maximum allowable cost for that drug.

(3) If a pharmacy's or a pharmacy services administrative organization's appeal is determined to be valid by the pharmacy benefit manager, the pharmacy benefit manager shall:

(4) A pharmacy benefit manager shall make price adjustments to all similarly situated pharmacies within 3 days.

(5) A pharmacy or a pharmacy services administrative organization shall file its appeal within 10 calendar days from the time of denial by the pharmacy benefit manager.