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No Veto in 2021: New Montana Governor Signs Pharmacy Benefit Manager Oversite Act into Law

Posted: May 20, 2021

During the 2019 legislative session in Montana, then Governor Steve Bullock vetoed a bill to place regulations around Pharmacy Benefit Managers (PBMs). In the veto message, the Governor cited that the bill would raise drugs costs, which is a common blanket response that health plans and PBMs feed legislators.

Even with the support of the Montana State Auditor’s office and numerous reports issued by state auditors from across the country showing PBMs pocketed millions in taxpayer dollars through their state Medicaid program, the bill failed to sway Bullock.

Thanks to Montana State Senator Greg Hertz, Auditor and Insurance Commissioner Troy Downing, and current Governor Greg Gianforte, the 2021 PBM bill (Senate Bill 395) passed with overwhelming support in both chambers. Named Pharmacy Benefit Manager Oversite Act, the bill provides the following provisions:

  • Requires PBMs to be licensed and regulated by the state of Montana.
  • Creates process to review complaints for misleading marketing and advertising by the PBMs.
  • Requires PBMs to submit a transparency report to the Montana Insurance Commissioner’s Office by July 1 of each year, to be included in a report released on December 31 of that same year.
  • Requests a report of the appeals received and denials made by PBMs  acting with pharmacists.
  • Provides Network Adequacy protections.
  • Establishes penalties and enforcement mechanisms.

The bill will now head to the Montana Insurance Commissioner’s Office, where the rulemaking process for implementation will take place. The CSRO is working to provide support to that office as the language is interpreted for regulatory review.

Questions?

Email us at info@csro.info.