6.6.7901    NETWORK ADEQUACY DEFINITIONS

(1)  The following definitions apply to this subchapter: 

(a)  "Mail-order pharmacy" means a pharmacy that provides pharmacist services and primarily dispenses and delivers covered drugs via common carrier.

(b)  "Pharmacy network" means a group of pharmacies contracted with a pharmacy benefit manager (PBM) to provide pharmacist services at negotiated prices to an enrollee or an injured worker of a workers' compensation insurance carrier.

(c)  "Preferred pharmacy network" means a subset, group, or tier of pharmacies that is designated as preferred within a pharmacy network that agrees to charge an enrollee or an injured worker of a workers' compensation insurance carrier a lower copayment, coinsurance, or deductible for pharmacist services or to accept a lower reimbursement rate than other pharmacies in the pharmacy network.

(d)  "Retail pharmacy" means any pharmacy that provides pharmacist services to the walk-in general public from which an enrollee or an injured worker of a workers' compensation insurance carrier could purchase a covered drug without being required to receive medical services from a provider or institution affiliated with that pharmacy. 

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.