6.6.7903    NETWORK ADEQUACY REPORTING

(1)  A PBM must submit the following reports and information for each pharmacy network as part of its license or license renewal application to demonstrate to the commissioner a sufficient and adequate pharmacy network: 

(a)  a report in a form and in a manner prescribed by the commissioner that designates the number and location of all retail pharmacies, mail-order pharmacies, and specialty pharmacies, if any, in each pharmacy network;

(b)  a network accessibility report that includes:

(i)  the access standard or standards the PBM establishes to determine network adequacy based on the number of miles between an enrollee or an injured worker of a workers' compensation insurance carrier and nearest retail pharmacy in the pharmacy network;

(ii)  the number of enrollees or injured workers of a workers' compensation insurance carrier with access to a retail pharmacy in the pharmacy network using the access standard established by the PBM;

(iii)  the average number of miles between the enrollees and injured workers of a workers' compensation insurance carrier identified in (ii) and the nearest retail pharmacy in the pharmacy network;

(iv)  the number of enrollees and injured workers of a workers' compensation insurance carrier without access to a retail pharmacy in the pharmacy network using the access standard established by the PBM;

(v)  the average number of miles between the enrollees and injured workers of a workers' compensation insurance carrier identified in (iv) and the nearest retail pharmacy in the pharmacy network; and

(vi)  the ratios of retail pharmacies in the pharmacy network to an enrollee or an injured worker of a workers' compensation insurance carrier; and

(c)  the PBM's process for monitoring and ensuring on an ongoing basis a sufficient and adequate pharmacy network to meet the pharmacist services needs of enrollees and injured workers of a workers' compensation insurance carrier.

(2)  A PBM must file and update the report required in (1)(a) with the commissioner if the number of pharmacies in the pharmacy network decreases by more than 5% during the year. 

 

History: 33-1-313, 33-2-2409, 33-2-2412, MCA; IMP, 33-2-2402, 33-2-2403, 33-2-2409, MCA; NEW, 2021 MAR p. 1899, Eff. 1/1/22.