All Roll Calls
Yes: 557 • No: 87
MontanaHB 74069th Legislature, Regular Session (2025)HouseWALLET
Revise laws relating to pharmacies, pharmacy benefit managers, and other entities
Sponsored By: Marta Bertoglio (Republican)
Signed by Governor
Contracts
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Bill Overview
Analyzed Economic Effects
9 provisions identified: 9 benefits, 0 costs, 0 mixed.
Minimum pay for independent pharmacies
Beginning 2025-10-01, independent pharmacies must be paid at least the NADAC in effect on the claim date plus a professional dispensing fee of at least $15 per prescription. If no NADAC exists for a generic drug, payment must be 100% of WAC plus the dispensing fee. The $15 fee increases every January 1 by the CPI (U.S. city average, all items). This rule does not apply to reimbursements under Title 39, chapter 71. These protections end 2029-06-30.
Same rules at any pharmacy
Beginning 2025-10-01, PBMs must use the same utilization rules, fees, copays, days’ supply limits, and other conditions no matter where you fill—local, mail order, or a PBM-owned pharmacy. PBMs cannot reimburse a network pharmacy less than the PBM’s contract price with the insurer, and they cannot require or coerce you to use a PBM-owned or affiliated pharmacy. If a mail-order drug is delayed more than one day after its expected date or arrives unusable, you may get it from a local network pharmacy. If USPS does not deliver to a physical address where you live, mail order cannot be required. These protections end 2029-06-30.
Fairer pharmacy contracts and network access
Beginning 2025-10-01, PBMs cannot require accreditation beyond state or federal licensure and may not exclude a new or relocated pharmacy unless there is a pending fraud, waste, or abuse investigation. PBMs must offer renewal at least every 3 years, allow 90-day termination, finish credentialing within 45 days, and process ownership changes so prescriptions can be filled within 30 days after documents are submitted. Pharmacies in a PSAO can get copies of PSAO contracts. PBMs must share processor control number, BIN, and group numbers, and contract changes take effect only when both sides sign. Pharmacies and PSAOs may sue in court to enforce these provisions. These protections end 2029-06-30.
Limits on PBM audits and recoupments
Beginning 2025-10-01, auditors may not include dispensing fees in recoupments except in four cases: not dispensed, prescriber denied authorization, pharmacy error, or the overpayment is only an extra dispensing fee. They may not collect money or penalties until the audit and all appeals are final, unless fraud or willful misrepresentation is clearly alleged and evidenced. Auditors cannot use extrapolation, cannot recoup solely over purchase timing, and must accept lawful purchase records from any date or source. No recoupment is allowed for clerical errors unless there is actual financial harm. Auditors cannot be paid on a percentage of recovery or charge interest during the audit. These rules end 2029-06-30.
PBM junk fees and payment rules
Beginning 2025-10-01, PBMs, payers, and discount card processors may not charge pharmacies claim submission, enrollment, credentialing, remittance, or other retroactive or claim-related fees. Reimbursements must be paid by bank transfer, check, or another method that does not charge the pharmacy a processing fee. If paid by check, the check must be depositable for 180 days. These rules end 2029-06-30.
Stop retroactive clawbacks and 'effective rates'
Beginning 2025-10-01, PBMs and payers cannot cut pharmacy payments through reconciliations to an "effective rate" or DIR-style fees. Contracts cannot set payment based on an aggregate "effective rate"; the law defines this practice. Performance-based fees may use only measures from a designated pharmacy performance measurement entity. These protections end 2029-06-30.
Timely, transparent pharmacy pricing data
Beginning 2025-10-01, PBMs and plan sponsors must share the sources they use to set pharmacy pricing and give pharmacies searchable access to plan-specific prices. They must update drug list prices at least every 10 calendar days and process increases on the same schedule as decreases. If using reference pricing, they must update at least every 10 business days and on the same date the source changes. A drug can be on a pricing list only if it is therapeutically equivalent, available from wholesalers in Montana, and not obsolete, unavailable, or on a shortage list. These requirements end 2029-06-30.
Pharmacists can share cheaper options
Beginning 2025-10-01, pharmacists may discuss how drugs are paid for and suggest lower-cost alternatives. Plans and PBMs may not punish pharmacists for this. Your copay cannot be higher than the total charges the pharmacy submits. HIPAA still limits some disclosures. These protections end 2029-06-30.
Pharmacy speech, delivery, and legal rights
Beginning 2025-10-01, PBMs and payers cannot stop a pharmacy or pharmacist from joining class-action lawsuits. Pharmacies may share adjudicated reimbursement information with plan sponsors or patients when allowed by HIPAA, and may give cost or clinical information about alternatives. Pharmacies may mail or deliver prescriptions where state law allows and may charge a shipping or handling fee when a patient requests it. These rules end 2029-06-30.
Sponsors & Cosponsors
Sponsor
Marta Bertoglio
Republican • House
Cosponsors
Steve Fitzpatrick
Republican • House
Roll Call Votes
House vote • 4/18/2025
Do Concur
Yes: 63 • No: 35
House vote • 4/17/2025
Do Concur
Yes: 92 • No: 8
Senate vote • 4/12/2025
Do Concur
Yes: 39 • No: 11
Senate vote • 4/10/2025
AMD-HB0740.004.001 Usher D/PASS
Yes: 50 • No: 0
Senate vote • 4/10/2025
Do Concur As Amended
Yes: 28 • No: 22
House vote • 3/7/2025
Do Pass
Yes: 98 • No: 1
House vote • 3/5/2025
AMD-HB0740.002.001 Bertoglio DO PASS
Yes: 89 • No: 9
House vote • 3/5/2025
Do Pass As Amended
Yes: 98 • No: 1
Actions Timeline
Chapter Number Assigned
5/8/2025HouseSigned by Governor
5/5/2025HouseTransmitted to Governor
4/28/2025HouseSigned by President
4/28/2025SenateSigned by Speaker
4/25/2025HouseRevised Fiscal Note Printed
4/22/2025HouseFiscal Note Unsigned
4/22/2025HouseReturned from Enrolling
4/21/2025HouseSent to Enrolling
4/18/2025House3rd Reading Senate Amendments
4/18/2025HouseRevised Fiscal Note Received
4/18/2025House2nd Reading Senate Amendments
4/17/2025HouseReturned to House with Amendments
4/12/2025Senate3rd Reading
4/12/2025SenateCommittee Report
4/11/2025SenateCommittee Executive Action
4/11/2025SenateHearing
4/10/2025SenateRereferred to Committee
4/10/2025Senate2nd Reading
4/10/2025Senate2nd Reading Motion to Amend
4/10/2025SenateRevised Fiscal Note Requested
4/10/2025HouseCommittee Report
4/8/2025SenateCommittee Executive Action
4/8/2025SenateHearing
3/27/2025SenateFiscal Note Unsigned
3/27/2025House
Bill Text
Enrolled
4/21/2025
As Amended (Version 5)
4/10/2025
As Amended (Version 4)
4/8/2025
As Amended (Version 3)
3/5/2025
As Amended (Version 2)
3/3/2025
Introduced
2/25/2025
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