Pharmacists for Fair Reimbursement What your state's PBM laws actually mean for community pharmacies
State Tracker Updated June 15, 2026

Idaho: what the PBM reimbursement law requires

Idaho requires PBMs to use pass-through (not spread) pricing, meet network-adequacy and anti-steering rules, and offer a MAC appeal — but it does not set a NADAC-based commercial reimbursement floor.

Status Partially enacted
Law HB 596 (2024) — Idaho Code § 41-349
Effective date January 1, 2025
Reimbursement basis No commercial reimbursement floor. PBMs must use pass-through pricing (spread pricing prohibited), meet network-adequacy and anti-steering requirements, and provide a MAC appeals process. Acquisition cost appears only as the level a MAC must be reset to if a generic-drug appeal is upheld — not a guaranteed payment floor.
Professional dispensing fee Not specified in the commercial statute (Idaho Medicaid separately pays actual acquisition cost plus a dispensing fee under its own rule)
Appeal route At least 30 business days to file (after a MAC update or claim adjudication); PBM responds within 30 business days

Idaho’s 2024 PBM reform (HB 596, effective January 1, 2025) requires pass-through pricing and bans spread pricing, sets network-adequacy and anti-steering rules, bars retroactive clawbacks, and provides a MAC appeal — but it does not create a commercial NADAC reimbursement floor.

The only acquisition-cost language is a remedy: if a generic-drug MAC appeal is upheld, the PBM must reset the MAC to at least the appealing pharmacy’s acquisition cost. That is an appeal outcome, not a floor on every claim. (Idaho’s Medicaid program separately reimburses on actual acquisition cost plus a dispensing fee, which is a Medicaid rule rather than the commercial PBM law.)

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