Senate Bill 1336 Summary

• Creates the "Pharmacy Benefit Manager Transparency Act" establishing Chapter 65, Title 41, Idaho Code, to regulate pharmacy benefit managers (PBMs) operating in Idaho.

• Requires all PBMs conducting pharmacy-related activities in Idaho to obtain an annual license from the Idaho Department of Insurance as of January 1, 2020, with license fees between $300-$700 and a $1,000,000 surety bond requirement.

• Prohibits PBMs from restricting covered persons' pharmacy choice, requiring use of specific pharmacies, or providing incentives to use PBM-owned pharmacies; prohibits conditioning network participation on participation in other networks managed by the same PBM.

• Establishes maximum allowable cost (MAC) transparency requirements including disclosure of pricing data sources, price adjustments at least twice monthly (within 3 business days for 100%+ price changes), and a pharmacy appeal process for up to 200 claims per appeal with timely response requirements.

• Declares violations to be unfair or deceptive acts under Idaho consumer protection law and authorizes the insurance director to impose administrative penalties and deny, suspend, or revoke PBM licenses for violations.