HB 596 - Pharmacy Benefit Managers

• Requires pharmacy benefit managers to register annually with the Idaho Department of Insurance by April 1 each year and prohibits their use without proper registration.

• Prohibits spread pricing and requires pass-through pricing models where payments to plans match reimbursements to pharmacies with 100% pass-through of manufacturer rebates.

• Mandates full disclosure of drug costs, reimbursement rates, fees, markups, and aggregate manufacturer remuneration to health plans and pharmacies.

• Establishes administrative appeal procedures allowing pharmacies to challenge maximum allowable cost pricing within 30 days, with pharmacy benefit managers required to respond within 30 business days and report appeal data every 90 days to the Department of Insurance.

• Prohibits pharmacy benefit managers from restricting pharmacy communications about treatment alternatives, cost-sharing information, or disclosures to regulators, and provides 90-day continuity of care when drugs are removed from formularies.

• Effective January 1, 2025.