ID H0215

Requires pharmacy benefit managers to register annually with the Idaho Department of Insurance by April 1 each year to perform, offer, or advertise 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 more affordable alternative drugs, and bars penalties for disclosing such information or selling affordable alternatives.

Establishes requirements for maximum allowable cost pricing, including ensuring drugs meet FDA therapeutic equivalence ratings, updating pricing at least every seven business days, and establishing a 30-day appeal process for network pharmacies to challenge reimbursement decisions.

Prevents pharmacy benefit managers from retroactively denying or reducing paid claims except in cases of fraudulent submission or when the pharmacy was already paid for the services.

Authorizes the Department of Insurance Director to impose actions, penalties, and remedies under Idaho Code sections 41-117, 41-1016, and 41-1026 for violations, effective July 1, 2023.