S1289 Summary

• Creates the Pharmacy Benefit Manager Transparency Act requiring all pharmacy benefit managers serving Idaho covered entities to register with the Director of Insurance by January 1, 2020, with 2-year renewable registrations effective for that period.

• Requires pharmacy benefit managers to disclose all financial information, conflicts of interest, payment arrangements with drug manufacturers, and formulary management details to covered entities, with audit rights granted to covered entities.

• Prohibits pharmacy benefit managers from restricting covered individuals' pharmacy choice and requires prescriber approval and full cost disclosure when substituting higher-priced drugs for prescribed medications.

• Establishes maximum allowable cost (MAC) pricing requirements for drugs with three or more therapeutically equivalent sources, updated every seven business days, with transparent pricing sources and process for network pharmacies to appeal reimbursement rates within 30 days.

• Declares waivers of chapter provisions void as contrary to public policy and defines violations as unfair or deceptive acts under Idaho's consumer protection laws, with enforcement by the Department of Insurance.