Investors on the libertarian fringe of the biotech industry are making their dream of wide-ranging access to experimental drugs a reality in Montana.

Last year, they helped draft a state law to expand access to drugs that no regulator has deemed safe and effective. Now, Montana is relying on a privately run board to decide which treatments to offer — raising concerns about conflicts of interest and, in an industry rife with unfounded claims, whether patients will get value for their money.

A company that works with biotech firms in a regulation-free zone off the coast of Honduras is in charge. Last month, the board authorized its first…

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