Current through Register Vol. 1, January 10, 2025
Rule 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.NEW, 2021 MAR p. 1899, Eff. 1/1/2022AUTH: 33-1-313, 33-2-2409, 33-2-2412, MCA; IMP: 33-2-2402, 33-2-2403, 33-2-2409, MCA