The bill aims to revise prior authorization laws by prohibiting health insurance issuers from requiring prior authorization for specific categories of prescription drugs. These include oral and inhaled generic prescription drugs, inhaled prescription drugs used for treating asthma, chronic obstructive pulmonary disease, or chronic lung disease, and insulin for diabetes patients. Additionally, the bill mandates that if an insurer makes an adverse determination regarding a prescription drug, they must provide a list of reasonable therapeutic alternatives that are covered under the insurer's formulary.

To implement these changes, the bill amends Section 33-32-221 of the Montana Code Annotated (MCA) by inserting provisions that clarify the types of drugs exempt from prior authorization and the requirements for adverse determinations. Specifically, it includes new language that specifies the conditions under which prior authorization cannot be applied, such as for certain generic drugs and insulin, and outlines the necessity for a physician's involvement in adverse determinations. The bill also emphasizes the requirement for insurers to communicate alternative treatment options to patients when a drug is denied coverage.

Statutes affected:
LC Text: 33-32-221
HB0399_1(1): 33-32-221
HB0399_1(2): 33-32-221
HB0399_1(3): 33-32-221
HB0399_1(4): 33-32-221
HB0399_1(5): 33-32-221
HB0399_1(6): 33-32-221
HB0399_1: 33-32-221
HB0399_2(1): 33-32-221
HB0399_2(10): 33-32-221
HB0399_2(2): 33-32-221
HB0399_2(3): 33-32-221
HB0399_2(4): 33-32-221
HB0399_2(5): 33-32-221
HB0399_2(6): 33-32-221
HB0399_2(7): 33-32-221
HB0399_2(8): 33-32-221
HB0399_2(9): 33-32-221
HB0399_2: 33-32-221
HB0399_X(1): 33-32-221
HB0399_X(2): 33-32-221
HB0399_X(3): 33-32-221
HB0399_X(4): 33-32-221
HB0399_X(5): 33-32-221
HB0399_X: 33-32-221