Bill > H0596

This bill amends existing law to establish provisions governing pharmacy benefit managers (PBMs). Key provisions include: - Defining important terms related to PBM practices, such as "brand name or generic effective rate," "dispensing fee," "maximum allowable cost," and "pass-through pricing model." - Requiring PBMs to register annually with the Department of Insurance and prohibiting practices that restrict pharmacies from providing cost information to patients. - Mandating that PBMs use pass-through pricing models, prohibiting spread pricing, and requiring 100% of manufacturer rebates to be passed back to the pharmacy benefits plan or program. - Establishing requirements for PBM participation contracts with pharmacies, such as providing an administrative appeal process for maximum allowable cost pricing, and prohibiting certain discriminatory practices against pharmacies. - Imposing reporting requirements on PBMs, including disclosing the difference between what they pay pharmacies and what they charge plans, as well as any changes to drug formulary tiers. - The bill will take effect on January 1, 2025.

Health and Social Services

Health and Welfare Committee (House)

https://legislature.idaho.gov/sessioninfo/2024/legislation/H0596/