Overview
Idaho has stepped up its efforts to promote price transparency and control healthcare costs in recent legislative sessions. Signed into law in 2020, the Idaho Patient Act adds transparency to the medical billing process and protects consumers from unfair medical debt collection practices. The state legislature also made a notable effort but failed to pass the No Surprises Act, which would have implemented surprising billing protections by prohibiting health care providers from charging higher rates for out-of-network services.
The state has also taken affirmative steps to curb anticompetitive practices in the healthcare market. Idaho law prohibits most favored nation clauses, or clauses having a similar effect, against hospital and service corporations, stock or mutual insurance companies, and managed care organizations entering into agreements with participating providers. Additionally, the state regulates non-compete agreements for physicians by requiring that such provisions be limited to protecting legitimate business interests.
Idaho further exercises regulatory oversight over the healthcare provider market by requiring written notice to the attorney general prior to entering into any nonprofit conversion or transaction. In a landmark antitrust enforcement case against St. Luke’s Health Systems and Saltzer Medical Group, the Idaho AG and the FTC filed a joint complaint to challenge the merger between the Idaho-based, not-for-profit health system and the state’s largest independent, multi-specialty physician group. 16 states filed an amicus brief to the Ninth Circuit, explaining that the acceleration of health care costs due to the growth of large health care provider systems has become a matter of grave concern for the states. The Ninth Circuit affirmed the federal district court’s ruling that the acquisition violated Section 7 of the Clayton Act and the Idaho Competition Act and ordered a full divestiture of Saltzer from St. Luke’s Health System, restoring competition in the local adult primary care services market.
In 2024, the state passed legislation providing for regulation and oversight of the practices of pharmacy benefit managers.
See below for an overview of existing Idaho state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/9/2023 - 4/8/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
H 0151 – Idaho
Introduced: 2015 Status: Inactive / Dead
AN ACT MAKING CERTAIN HEALTH INSURANCE EXCHANGE INFORMATION AVAILABLE: would require the health insurers on the Idaho Exchange to make available the following information: (i) prescription drugs covered by the plan, including restrictions on use …
HB 115 – Idaho
Introduced: 2021 Status: Enacted
HOSPITALS — Amends existing law to provide that a hospital trustee may not be an employee of or have an ownership interest in certain other facilities and to revise provisions regarding hospital boards.
HB 149 – Idaho
Introduced: 2019 Status: Enacted
SELF-FUNDED HEALTH CARE PLANS: Amends existing law to provide for a waiver of surplus requirements if a self-funded plan meets certain conditions
HB 162 – Idaho
Introduced: 2023 Status: Enacted
The legislation expands the ability of Idaho citizens in rural and underserved areas to access health care from providers who are not physically present in a patient’s geographical area. The legislation updates the Idaho Telehealth …
HB 179 – Idaho
Introduced: 2021 Status: Inactive / Dead
OCCUPATIONAL LICENSING – Amends existing law to provide for interstate telehealth access.
Idaho Code Ann. § 41-3930. Utilization management program requirements: Managed Care Reform Act – Idaho
Introduced: Status: Enacted
All managed care organizations performing utilization management or contracting with third parties for the performance of utilization management shall adopt utilization management criteria based on sound patient care and scientific principles developed in cooperation with …
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Idaho Code Ann. § 41-3940. Preexisting conditions: Managed Care Reform Act – Idaho
Introduced: Status: Enacted
Any managed care organization issuing benefits shall be ready and willing to enter into care provider service agreements with all qualified providers of the category which are necessary to provide the health care services covered …
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Idaho Code Ann. § 54-1733. Validity of prescription drug orders: Idaho Pharmacy Act – Idaho
Introduced: Status: Enacted
A prescriber who is otherwise authorized to perform any of the activities listed in this section may prescribe or perform any of the following activities for a patient with whom the prescriber does not have …
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Idaho Code Ann. § 54-1768. Prescriber-authorized substitution: Idaho Pharmacy Act – Idaho
Introduced: Status: Enacted
A licensed prescriber may authorize a pharmacist to substitute a drug with another drug in the same therapeutic class that would, in the opinion of the pharmacist, have a substantially equivalent therapeutic effect even though …
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Idaho Code Ann. § 54-1769. Communication regarding biological products: Idaho Pharmacy Act – Idaho
Introduced: Status: Enacted
A pharmacist who dispenses a biological product shall communicate to the prescriber the name and manufacturer of the drug within five business days following the dispensing of the biological product. Communication shall occur via an …
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Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Idaho operates on an annual budget cycle. The legislature adopts the budget in March and the fiscal year begins in July.
STATE LEGISLATURE
The Idaho statehouse has 35 senators and 70 representatives in the House of Representatives. Both senators and representatives are elected to two-year terms. The Legislature meets annually from January until mid-March, although sessions have been known to last into May. The Governor of Idaho may also call special sessions at any time. Bills do not carry over from year to year.