ID H0386

Pharmacy benefit managers must register annually with the Idaho Department of Insurance by April 1 each year and cannot perform pharmacy benefit management services without registration.

Pharmacy benefit managers cannot prohibit pharmacists or pharmacies from informing patients about prescription drug cost shares or more affordable alternative medications, and cannot penalize pharmacies for disclosing this information or dispensing more affordable alternatives.

Pharmacy benefit managers using maximum allowable cost pricing must ensure drugs are FDA-rated "A" or "B" (or have "NR"/"NA" ratings), are available from national or regional wholesalers, and must review and update pricing at least every 7 business days.

Network pharmacies must be provided pricing sources at contract entry or renewal and have the right to appeal generic drug reimbursement decisions within 30 days; pharmacies must have ready access to their specific maximum allowable cost lists.

Pharmacy benefit managers cannot retroactively deny or reduce adjudicated claims except when the claim was submitted fraudulently or improperly, or when duplicate payment has already been made to the pharmacy.