In Review: The Montana legislature has introduced multiple bills this session that significantly impact PBM operations, insurance policy structures, and patient access to healthcare services. Sixteen bills focus on prior authorization with conflictions and duplications between bills and enforcement. If all 16 bills passed, Montana would have the most passive prior authorization safeguards in the country. Drug coverage mandates are also a focal point, with SB 417 requiring GLP-1 weight-loss drug coverage without step therapy, while LC 3697 includes similar provisions but retains step therapy protocols, leading to uncertainty in formulary management. Additionally, LC 2288 and HB 590 regulate emergency ambulance costs and insurer reimbursements, yet their differing rate structures may create inconsistencies in how insurers process claims. Medicaid policies are also impacted, as SB 361 limits PBMs’ ability to deny Medicaid claims for technicalities. At the same time, LC 3198 introduces automatic approvals if PBMs fail to meet deadlines, raising concerns about fraud prevention and cost containment.

Up Next: PCMA and Member companies testified on Friday, February 21 in the House Business and Labor Committee on HB 398, HB 399 (prior authorization) and HB 544 (Retroactive Denials and Biologic Therapies for Minors). With the transmittal deadline on March 5, and all filed bills receiving a hearing, additional bills will be heard in the Senate Public Health Welfare and Safety, House Human Services and House Business and Labor this week.

If you have any questions, please contact Tonia Sorrell-Neal at tsorrell-neal@pcmanet.org.