Effective January 1, 2025, Idaho has new expectations for reporting requirements of Pharmacy Benefit Managers (PBMs), including health insurers who perform the activities of a PBM. 
- PBMs are required to report to the Idaho Department of Insurance on January 1, 2025, and then annually.
- The difference in the amount paid to each pharmacy and the amount charged to health plans, aggregated by each pharmacy.
- Transparently disclose why a drug was moved to a tier that results in higher costs to a consumer or lower reimbursement to a pharmacy.
- A PBM that owns, controls, or is affiliated with a pharmacy must report differences paid between affiliated and nonaffiliated pharmacies.
- PBMs are required to submit quarterly reports to the Department of Insurance on appeals and denial outcomes including reasons for each denial, for each specific drug for which an appeal was submitted.
All required reporting should be sent via email to pbm@doi.idaho.gov. Failure to submit timely reporting may result in administrative action. Please see the attachment for more information.

Our compliance experts are constantly searching for and analyzing industry updates. Their findings are then recorded in the Regulatory Updates section of the Compliance Library to explain how the update impacts the insurance industry. If a change impacts an AgentSync product, this will be highlighted to inform you that the product is being updated to ensure you remain in compliance.