Idaho Bills

Adds to existing law to provide for transparency for pharmacy benefit managers.

Pharmacy Benefits Managers (PBMs) are middlemen that were originally designed to reduce administrative costs for insurers, validate patient eligibility, administer plan benefits, as well as negotiate costs between pharmacies and health plans. Today PBMs have control over almost all aspects of the prescription drug transactions, with the three largest PBMs managing 78 percent of the prescription drug benefit transactions. The purpose of this legislation is to establish a Pharmacy Benefit Manager Transparency Act that includes registration and disclosure of information requirements. In addition, it would establish transparency of the covered prescription drug lists and the methodology that determines how reimbursement to the pharmacies is ultimately calculated.

Adds to existing law to provide for applicability, to provide for required practices for pharmacy benefit managers, to provide for enforcement, and to provide maximum allowable cost transparency requirements for pharmacy benefit managers.

Pharmacy Benefits Managers (PBMs) are middlemen that were originally designed to reduce administrative costs for insurers, validate patient eligibility, administer plan benefits, as well as negotiate costs between pharmacies and health plans. Today PBMs have control over almost all aspects of the prescription drug transactions, with the three largest PBMs managing 78 percent of the prescription drug benefit transactions. The purpose of this legislation is to establish a Pharmacy Benefit Manager Transparency Act so that pharmacies in Idaho have all the information needed to make operational business decisions. The legislation would create and give oversight of PBMs that operate in Idaho to the Idaho Department of Insurance (DOI), along with establishing transparency of the covered prescription drug lists and the methodology that determines how reimbursement to the pharmacies is ultimately calculated.