Key Points

• New data confirms that major regulatory reforms passed during the 2021 and 2023 legislative sessions have driven a significant expansion of healthcare access in Montana, helping to ease chronic healthcare shortages.
• Since the repeal of Certificate-of-Need (CON) laws through HB 231 (2021), the number of businesses providing home health, outpatient surgery, and inpatient drug rehabilitation services in Montana has surged by 12.5%, after stagnating for years. We have also confirmed substantial geographic service area expansions from home health agencies.
• Since legalizing in-office dispensing for medical practitioners under SB 374 (2021), 148 practitioners have now registered to dispense medications directly to their patients in Montana, saving their patients an extra visit to the pharmacy. Many are offering to dispense in-office medications at or near wholesale prices, which can be a substantial cost savings for patients.
• Since expanding pharmacist prescribing authority under SB 112 (2023), Albertsons and Safeway report having at least 72 pharmacists on staff at their locations across the state who have written prescriptions, treating over 200 types of conditions such as strep throat, asthma, and urinary tract infections (UTIs) and saving their patients an additional visit to the doctor’s office.
• Reducing the red tape and burdensome regulations imposed on the healthcare system has proven to be an effective way to expand healthcare access in Montana without the need for spending taxpayer money. This approach should serve as a model for future reforms.

Introduction

One of Montana’s greatest challenges continues to be chronic healthcare shortages. In fact, our entire state is technically designated by the federal government as “medically under served.” Some rural counties remain without a local primary care physician. A lack of access to primary care not only jeopardizes the health of Montana communities but also can impact affordability, turning conditions that could have been addressed through timely, routine treatment into expensive ER visits.

Working alongside the legislature and Gov. Greg Gianforte’s administration, Frontier Institute identified, drafted, and championed numerous successful regulatory reforms in the 2021 and 2023 legislative sessions to expand access to affordable, quality healthcare in Montana. These reforms focused on removing red tape blocking the creation of new healthcare options and expanding the ability of existing practitioners to care for patients.

This report reviews the impact of three of those reforms:

• Repealing Certificate of Need (CON) Laws (HB 231, 2021)
• Legalizing in-office dispensing for medical practitioners (SB 374, 2021)
• Expanding Pharmacist Prescribing Authority (SB 112, 2023)

Certificate of Need Laws

Background

Up until 2021 Montana was one of 35 states still enforcing Soviet-style “certificate of need” (CON) regulations for healthcare services. At the time, Montana required a CON for:

• home health agencies
• outpatient surgery centers
• nursing homes
• in-patient drug rehabilitation facilities

Montana’s CON laws required healthcare providers to obtain government permission to open or expand their business. Applicants would have to prove to the state a new or expanded service was “needed.” Even worse, during the application process the government would then survey market incumbents and ask if new competition would cut into their bottom line — effectively giving competitors power to block new entrants.

By setting the supply of healthcare through regulatory decree, research had shown Montana’s CON laws were stifling competition, limiting access, and driving up costs.

An effort in the 2019 legislature to repeal Montana’s CON program was actually vetoed by Gov. Steve Bullock, who said the CON laws “prevent the creation of excess capacity in health care facilities.” In other words, the laws reduce competition that could increase access and decrease costs.

Frontier Institute’s 2020 Montana Recovery Agenda report proposed repealing CON laws, which prompted then Rep. Matt Regier to collaborate with FI on drafting HB 231 to enact this reform in the 2021 state legislative session. HB 231 was eventually passed and signed by Gov. Gianforte, officially repealing all but one of Montana’s CON laws, leaving nursing homes as the only major category still regulated.

National experts called Montana’s CON reforms at the time “the most significant [CON] reform in any state in recent years.”

HB 231 officially took effect as of October 2021, opening up the market for inpatient addiction care, home healthcare and outpatient surgery centers.

2025 Update

According to data provided to Frontier Institute by DPHHS, the total number of businesses providing home health, outpatient surgery, and inpatient rehabilitation services in Montana has surged by 12.5% since the repeal of CON in October 2021. This marks a substantial growth in new businesses joining the market compared to the previous 4 years, which showed only a stagnant 0% increase in businesses providing services.

The change in total number of licenses for each type of provider over time can be seen below:

The trends in active licenses are largely explained by two factors:

1. The slowing and eventual halt of decline among home health agencies and inpatient addiction treatment facilities, followed by gradual recovery after the repeal of the CON law.
2. A long-term upward trend in outpatient surgical centers that continued steadily through the post-repeal period.

While harder to track, Frontier Institute has also confirmed substantial geographic service area expansions from home health agencies since CON repeal. In email correspondence in June 2022, DPHHS officials confirmed that two Montana home health companies had expanded service to at least 18 additional counties, something that would have required a CON approval before.

In-Office Dispensing

Background

Until 2021, Montana was one of only five other states that prohibited doctors from dispensing the medicine they prescribe directly to patients in most instances, requiring patients to make an additional trip to a pharmacy to pick up their medication.

Frontier Institute promoted extensive research which showed legalizing in-office dispensing was a proven way to safely improve access to medications:

• Doctor dispensing is equally as safe as when prescriptions are filled at the pharmacy
• Doctor dispensing can be more convenient for patients, which improves medication adherence and leads to better health outcomes that save healthcare costs long-term.
• With insurance co-pays often exceeding the cash price of drugs, doctor dispensing allows patients another option to bypass supply chain middlemen and save on prescription costs.
• Purchasing doctor dispensed medicine with cash can be a cost-effective option for patients, especially for those who are uninsured or have high deductible health plans.

Frontier Institute’s 2020 Montana Recovery Agenda report proposed legalizing doctor dispensing, which prompted Sen. Cary Smith to collaborate with FI on drafting SB 374 to enact this reform in the 2021 state legislative session. SB 374 went a step further and broadly legalized in-office dispensing of non-opioid medications for all medical practitioners qualified to prescribe, including physician assistants and nurse practitioners.

SB 374 was eventually passed and signed by Gov. Gianforte.

The Wall Street Journal’s Editorial Board praised the passage of SB 374 as “a victory for competition and common sense.”

SB 374 officially took effect as of October 2021.

2025 Update

To evaluate the impact of SB 374, we examined data from the Montana Board of Pharmacy detailing the number of medical practitioners registered to dispense prescription medication in Montana. Prior to 2021, no such data existed, so a 2020 study serves as our baseline, showing that only 28 Montana physicians were qualified to dispense under the restrictive regulations previously in place. With the passage of SB 374, medical providers could register with the Board of Pharmacy, creating a verifiable record.

According to the Board of Pharmacy data,148 practitioners have now registered to dispense medications directly to their patients in Montana since legalizing in-office dispensing under SB 374 (2021), saving patients an extra visit to the pharmacy.

The graphic below depicts the recorded increase in medical practitioners registered for in-office dispensing:

Current registrants include physicians, physician assistants, and advanced practice registered nurses, demonstrating that this expanded authority is being actively used across Montana’s healthcare workforce.

Frontier Institute was also able to identify several providers who are bypassing the middlemen involved in complicated insurance billing to dispense medications directly to patients, either at wholesale prices or with a minimal markup, potentially leading to substantial cost savings. For example, a price comparison of medications dispensed at Flex Family Health in Billings shows their patients can access many medications at less than half the retail price of most pharmacies. Depending on a patient’s insurance coverage, this low pricing may even be less than the co-pay that patients would normally pay if billing insurance for the medication.

More data is needed to widely quantify cost savings resulting from in-office dispensing to Montana patients.

Pharmacist Prescribing

Background

Until 2023, Montana pharmacists were prohibited from prescribing most medications, despite their extensive knowledge and skillset with pharmaceutical drugs and status in many rural areas as the most local point of contact for primary healthcare.

Patients seeking medications even for routine ailments had to make a separate appointment with a primary care provider to secure a prescription, which could often entail long wait times or travel – all despite their local pharmacist being fully trained to handle their care.

​​In 2019, Idaho authorized pharmacists to safely prescribe medications for minor, non-emergency ailments that do not require a new diagnosis and can be identified with a low-risk test, such as a UTI or strep throat. Patients who required only routine prescriptions could now get them conveniently from their local pharmacy, saving an unnecessary trip to the doctor’s office. Additionally, local community pharmacies are often open longer than doctors’ offices and no appointment is needed — which made care even more accessible.

Studies have demonstrated that Idaho’s reforms have led to significant increase in access to time-sensitive prescriptions like albuterol inhalers and insulin pens, helping prevent costly emergency room visits.

Frontier Institute’s 2022 Healthcare Policy Playbook proposed expanding pharmacist prescribing in Montana by modeling Idaho’s reforms. FI collaborated with the Montana Pharmacy Association to draft SB 112 for the 2023 state legislative session, which was carried by Sen. Tom McGillvray.

SB 112 was eventually passed and then signed by Gov. Gianforte, officially allowing Montana pharmacists to independently prescribe routine medications to patients, an authority only allowed in a handful of other states.

2025 Update

There is no registration or licensing with the state needed for pharmacists to utilize the new prescribing authority under SB 112, so government data about the implementation of SB 112 does not exist.

However, Frontier Institute was able to review data provided directly by Albertsons and Safeway stores, which have now implemented SB 112’s expanded prescribing authority in their pharmacies across Montana.

Between Jan 1st and Sept 6th, 2025 Albertsons and Safeway report having at least 72 pharmacists on staff who have written prescriptions across their 32 locations in the state, treating over 200 types of conditions such as strep throat, asthma, and urinary tract infections (UTIs), saving their patients an additional visit to the doctor’s office.

The chart below provides an overview of the conditions addressed through pharmacist prescribing services, as reported by Albertsons and Safeway stores:

Adoption of SB 112’s pharmacist prescribing authority will likely continue to expand in Montana. Other pharmacies, such as Walmart, have announced over the past year that they are launching pilot programs to adopt the expanded prescribing authority under SB 112 in their pharmacies.

A study is currently underway for the Journal of American Pharmacists Association to comprehensively assess the implementation of SB 112, so more data about the impact of expanding pharmacist prescribing in Montana should be available soon.

Conclusion

The data reviewed in this report confirms that major regulatory reforms passed during the 2021 and 2023 legislative sessions to repeal CON laws, legalize in-office dispensing of medications, and expand pharmacist prescribing authority have driven a significant expansion of healthcare access in Montana, helping to ease chronic healthcare shortages

Reducing the red tape and burdensome regulations imposed on the healthcare system has proven to be an effective way to expand healthcare access in Montana without the need for spending taxpayer money. This approach should serve as a model for future reforms.