ID H0363

Requires pharmacy benefit managers to register annually with the Idaho Department of Insurance by April 1 each year to perform or offer pharmacy benefit management services in the state.

Prohibits pharmacy benefit managers from preventing pharmacists or retail pharmacies from informing customers about cost-sharing amounts and disclosing information about more affordable alternative drugs.

Establishes requirements for maximum allowable cost pricing, including ensuring drugs are FDA-approved with A or B ratings, updating pricing information at least every seven business days, and providing network pharmacies with pricing sources and appeal processes.

Allows network pharmacies to appeal reimbursement decisions for generic drugs within 30 days of reimbursement.

Prohibits pharmacy benefit managers from retroactively denying or reducing adjudicated claims except when the claim was submitted fraudulently or the pharmacy was already paid for the services.