Commissioner seeks comments on potential House Bill 740 rulemaking regarding, pharmacy audit, reimbursement and prohibited practices

Commissioner James Brown emphasizes the importance of public engagement in shaping responsible policies and asks stakeholders to consider the following questions when commenting on potential rulemaking:

1. Does the definition of independent pharmacy outlined in House Bill 740 require additional regulatory clarification? Does the definition create the unintended inclusion of other pharmacy business models outside of similar independent or community pharmacies? Does the current definition for pharmacy benefit managers require further clarification? If so, what considerations should be made for clarity in administrative rules?
2.  How should “third-party payer” be further clarified in administrative rule, especially regarding self-insured employer arrangements, discount plans, and non-traditional payers?
3. Are there specific, objective criteria or documentation that could be required to verify a pharmacy’s status as “independent” under House Bill 740, e.g. attestation forms, accreditation records, ownership documentation, affiliation disclosures? Would periodic re-certification be helpful to ensure continued compliance?
4. House Bill 740 mandates a minimum reimbursement floor for independent pharmacies. Is further clarity required in the form of administrative rule to define the methodology, calculation or process to update that floor? What source should the agency use when considering the Wholesale Acquisition Cost?
5. The use of maximum allowable cost (MAC) pricing and reference lists is contemplated in §33-22-172. Are there additional MAC list considerations that are not addressed in this section, such as retention and availability of MAC list & reference pricing history, additional specificity regarding accessibility of such lists, concerns regarding use of more than one MAC list or reference pricing tool, or other aspects of MAC/reference pricing?
6. What provisions, if any, should be established in rule for reimbursement audits and recoupments? From the perspective of pharmacy benefit managers and third-party payers, what clarifications in rule would help facilitate consistent application of the new fee and audit prohibitions in House Bill 740?
7. What additional reporting requirements, if any, should PBMs, payers, or pharmacies have under the rules? Should the rules contemplate a required timeframe for advance notice of contract changes? How should any reporting requirement of the pharmacies or PBMs treat proprietary information that may be protected data?
8. The bill adds provisions limiting the PBM’s ability to add drugs to a Maximum Allowable Cost list if they are temporarily unavailable. What length of time should constitute temporary and what source of data should the agency use in enforcing the lists?
9. Are there existing arrangements with independent pharmacies that are jeopardized by any provisions of House Bill 740? Please indicate whether these arrangements could be addressed by rulemaking within the provisions of House Bill 740 or whether future legislative action is needed.
10. What role will pharmacies/beneficiaries have in filing complaints or initiating investigations under the rule?
11. Should the rules specify periodic review or audit of compliance by the agency?
12. Are the any further considerations that the agency should consider in drafting rules for House Bill 740?

A public hearing on the development of rules will be held January 8, 2026, the Commissioner encourages interested parties to submit written comment in addition to public comments made during the hearing.

Based on the public comment received during the hearing and in the written submissions, the Commissioner intends to publish proposed rules in the Montana Administrative Record. Stakeholders and the public will have an opportunity to provide public comment on the proposed rules before they are formally adopted.

Public Hearing Information

9 a.m., January 8, 2026