Bill > S1367

This bill establishes new rules for how pharmacies are reimbursed for prescription drugs and places new restrictions on pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits for health plans. Key provisions include requiring plan sponsors, PBMs, and third-party payers to reimburse independent pharmacies at least the national average drug acquisition cost (NADAC) plus a minimum professional dispensing fee of $12.35, which will be adjusted annually for inflation. The bill also defines "independent pharmacy" as one not owned or affiliated with a PBM and clarifies that PBMs cannot prohibit pharmacists from discussing drug costs or more affordable alternatives with patients, nor can they penalize pharmacies for doing so. Furthermore, PBMs are prohibited from charging a pharmacy benefits plan more than they reimburse a pharmacy for ingredient costs or dispensing fees, and they must apply the same network conditions to all pharmacies, including their own affiliated ones. The bill also outlines various fees that PBMs and third-party payers cannot charge pharmacies, mandates direct bank transfers or checks for reimbursements, and prevents PBMs from retroactively denying claims unless there's fraud or an error. Finally, PBMs are required to provide detailed disclosures about drug costs, fees, and rebates, and to implement specific contract terms related to pricing models, rebate pass-through, network adequacy, and appeal processes for reimbursement disputes.

Business and Industry, Justice

State Affairs Committee (Senate)

https://legislature.idaho.gov/sessioninfo/2026/legislation/S1367/