Idaho Bills

Adds to existing law to provide certain registration and reporting requirements, to prohibit certain actions, to provide certain requirements for maximum allowable cost pricing, and to prohibit the retroactive denial or reduction of a claim in certain instances.

Pharmacy benefit managers (PBMs) are third party administrators under contract by health plans, employers, and government entities to manage prescription drug programs for health plan recipients. This bill does four key things: 1. Adds transparency to the pharmacy process in Idaho by requiring PBMs that operate in our state to register annually with the Department of Insurance; 2. Provides Idaho pharmacists more flexibility in informing patients how they can pay less out-of-pocket for prescriptions by prohibiting "gag clauses." Currently, gag clauses are prohibited by Federal law on Medicare Part D and Advantage plans; this legislation extends that to all plans that operate in the state; 3. Ensure transparency by PBMs on how they determine the maximum allowable cost (MAC) they reimburse pharmacies for prescriptions and require PBMs to update pharmacies regularly on MAC price changes; and, 4. Prohibits PBMs from retroactively denying or reducing a claim for reimbursement, except for legitimate reasons.