Bill > H0353

This bill establishes new regulations for cost-sharing requirements in health benefit plans, specifically focusing on prescription drug assistance. The bill defines cost-sharing requirements as copayments, coinsurance, deductibles, or annual cost-sharing limitations. When calculating an enrollee's contribution to prescription drug costs, insurers must include all cost-sharing amounts paid by the enrollee or on their behalf. Pharmaceutical manufacturers providing financial assistance must offer the full value of that assistance to the enrollee until their cost-sharing requirements are met, cannot discontinue coupons mid-year, must notify enrollees about assistance changes, and are prohibited from providing post-claim reimbursements. Manufacturers are also required to annually report to the Idaho Department of Insurance detailed information about their prescription drug assistance programs, including patient numbers, total assistance value, and sales data. The bill applies to health benefit plans entered into or renewed after January 1, 2027, and does not apply to prescription drugs with medically appropriate generic equivalents when a doctor confirms the generic is suitable. The Department of Insurance is authorized to create rules to implement these provisions, subject to legislative approval.

Health and Social Services

Health and Welfare Committee (H)

https://legislature.idaho.gov/sessioninfo/2025/legislation/H0353/