MT SB446

Only physicians with a current, valid nonrestricted Montana medical license may make adverse determinations or review grievances for utilization review organizations, and they must specialize in the condition being reviewed.

Physicians reviewing grievances cannot have been involved in the original adverse determination or have a financial interest in the outcome.

Health insurers are prohibited from requiring prior authorization for FDA-approved substance use disorder medications within labeled dosages, adding to existing exemptions for generic drugs used 6+ months, previously approved drugs, dosage adjustments, and long-acting injectable antipsychotics.

Adverse determinations for prescription drugs during prior authorization must be made by a physician specializing in the condition the drug treats.

Sections 1 and 2 become void if House Bill No. 398 is also passed and approved.