Pharmacy Benefits
Effective until January 1, 2025, PBMs are required to comply with Idaho Code § 41-349. The requirements apply to the PBM’s administration of prescription drug benefits to Idahoans and its contracts with Idaho pharmacies and pharmacy benefit plans or programs.
Before submitting a complaint, please consider the following:
- Have you attempted to contact the PBM in an effort to resolve the matter?
- If so, please include their response as attachments included within your complaint.
Additional Information to consider before filing a complaint:
- If this complaint consists of multiple claims relating to MAC Appeals, Adjudication Fees or Dispensing Fees, we encourage you to complete the following two forms:
– Blank Manual PBM Complaint Form v4 – Fillable
– ID DOI Pharmacy Claim Payment Complaint Template – Fillable
- Submit both forms in one emailed complaint to: pbm@doi.idaho.gov. If your complaint includes supporting documentation, please include this within your email submission to: pbm@doi.idaho.gov.
- Any missing information from the initial email may be requested through the PBM complaint form if necessary.
- Please complete separate form(s) for each PBM if there are multiple complaints.
To notify the Department of other possible violations, please contact the Department using the button below.
Contact the DOI:
Idaho Department of Insurance
ATTN: Pharmacy Benefit Market Examiner
700 W State St, 3rd Floor
Boise ID 83720-0043
Fax: (208) 334-4398
Email