David Leavitt — Representative Leavitt questions why the RS caps participation at 100 eligible practitioners per specialty and follows up by asking whether the program is being broadened to include more individuals from different sectors.
David Leavitt — Asked whether the bill should include an ombudsman to advocate for children.
Dori Healey — Asks how many Idaho plans currently use accumulators.
Dori Healey — Representative Healy raised concerns that the bill, as written, applies broadly to third-party cost-sharing payments and may overlap with existing Idaho Code 41-348. He also questioned how the measure would affect small Idaho employers, particularly whether it could increase premium pressures and shift additional costs onto them.
Dori Healey — Said she has gone back and forth on the bill and is concerned it shifts liability and increases premium pressure.
Dori Healey — Questioned where the costs go and said the bill redistributes rather than lowers drug costs.
Dori Healey — Said she needs a better model of where the costs go before she can agree and will oppose the bill.
Dori Healey — The transcript appears to misidentify the next speaker as 'Kaler'; likely a different member name is intended.
Dori Healey — Requested a roll call vote.
Dori Healey — Called during roll call.
Dori Healey — Referenced as a collaborator on the bill.
Dori Healey — Representative Healey asked to add to the discussion and then explained that prior authorizations, while important in many ways, can be overwhelming and time-consuming.
James Ruchti — Representative Furman discussed the bill’s impact on copay accumulators and patient assistance. He shared a personal example of using a medication coupon that reduced his deductible, noted that accumulators are used broadly across plans but did not know the exact number, explained that the legislation applies to assistance with co-pays, deductibles, and co-insurance rather than only pharmaceuticals, and then deferred a question about the generic-equivalent exception because he did not have the bill text in front of him.
Robert Beiswenger — Representative Beiswenger asked who determines whether a medically appropriate generic equivalent exists and whether there is a process for making that determination, in the context of the bill’s applicability.
Robert Beiswenger — Robert Beiswenger stated that he could not support the motion, arguing that government intervention, regulation, and subsidization contribute to the high cost and unaffordability of health care and expressing support for a freer market approach. He concluded by saying he would vote no, and the later roll call recorded his vote as no.
Brent Crane — Representative Cannon responded to questions about how the bill would operate, explaining that disputes over coverage would initially be between the insurance company and the patient and, if necessary, resolved through normal dispute processes such as arbitration or litigation. He said pharmacists would have some role in determining the appropriate medication, and that the bill would not apply in situations where a pharmacist indicates a generic drug would address the condition. He then clarified confusion over the term "diverting," explaining that the legislation is aimed at how health insurers account for third-party funds and patient payments, essentially as an accounting issue involving credit for payments made on a patient’s behalf. Cannon also agreed that pharmaceutical companies may be acting out of self-interest to induce use of their products, acknowledged that coupons could theoretically make a product appear cheaper initially and influence later use, and concluded that free-market principles depend on a level playing field that he does not believe exists in this context.
Josh Tanner — Representative Tanner questioned Representative Cannon about the bill’s treatment of co-pay assistance funds, asking where the money would be diverted and what specific section of the handout or bill he was referring to. He then raised a broader concern that coupons could function as an inducement and asked how the bill would avoid that problem.
Josh Tanner — Was thanked after asking a question.
Bruce Skaug — Representative Cannon argued that copay accumulator practices are not something consumers knowingly agree to, since patients usually discover them months after starting expensive medication and do not read or understand the full insurance contract. He said free contracting is largely theoretical in this context and that the bill would not conflict with Idaho’s anti-kickback statute because coupon programs are a common, lawful industry practice. He emphasized that the legislation does not change drug prices, only how patient assistance is credited toward copays and out-of-pocket maximums. Cannon also said any resulting premium increase would likely be modest and acceptable if it prevents a small number of patients from being unfairly burdened by high drug costs, and he clarified that the bill does not apply when a medically appropriate generic equivalent exists.
Faye Thompson — Asked whether uninsured people are eligible for coupons.
Faye Thompson — Referenced as part of the prior discussion Healy was following up on.
Faye Thompson — Faye Thompson opposed the bill, arguing that Medicaid and Medicare patients are not eligible for the coupons and that the bill is unfair to patients. She stated she was definitely a no, and her vote was recorded as no.
Charlie Shepherd — Referenced as having raised a prior thought that Healy was following up on.
Dale Hawkins — Representative Kaler asked whether a transparency requirement would be acceptable, and was then directly addressed in the response during the same exchange.
Tiffany Machen — Named as the first witness to testify.
Tiffany Meekum — Tiffany Meekum, an Idaho resident and health care advocate, testified in support of House Bill 713. She explained that many Idaho patients depend on co-pay assistance programs to afford essential medications, especially when no generic alternatives exist, and argued that accumulator programs disproportionately harm these patients and can increase long-term costs. She concluded by urging lawmakers to support the bill and stand with Idaho patients.
Liesel Drollinger — Liesel Drollinger testified in support of the bill and explained that her family is affected because her daughter Emerson needs an expensive, life-changing medication. She described how earlier grim medical projections for Emerson have not come to pass, emphasized that the family is not anti-insurance, and said their health plan’s co-pay accumulator prevents them from receiving assistance or making patient assistance programs worthwhile to pursue. The exchange concluded with a follow-up question about the lifelong impact on the family and the possibility of generics.
Josh Wheeler — Representative Wheeler followed up on Ms. Drollinger’s testimony about her daughter’s medication costs and deductible treatment, asking whether outside assistance with medication payments counted toward the deductible and whether, after the insurer changed the contract, open enrollment had already ended so the family had no other insurance option.
Josh Wheeler — Representative Wheeler thanked Mr. Thomas for testifying and asked about the association's letter and its position on House Bill 353 from the previous year, including whether the association was more favorable toward that bill. The exchange centered on the association's involvement with and views on House Bill 353.
Josh Wheeler — Asked for a motion and then moved House Bill 713 to the floor with a due pass recommendation.
Josh Wheeler — Thanked the chair and praised Representatives Furman and Cannon for bringing the legislation forward.
Josh Wheeler — Josh Wheeler first voted aye during roll call, then introduced himself as the presenter for House Bill 655, identifying his district and counties. He explained that the committee was considering HB 655 along with RS 33527, and said the bill builds on work from the previous session with Representative Healey to continue the committee’s earlier efforts.
Ms. Drollinger — Ms. Drollinger explained that her family switched insurance after confirming with HR that the plan did not have a copay accumulator, only for the insurer to later reverse that representation after they had enrolled and believed their deductibles were met. She said the family is glad the medications are available, but they need assistance that actually helps with costs, which the current arrangement does not provide.
Mr. Hollinger — Mr. Hollinger explained that his family uses generic medications when they are available, but whether a generic can be used is determined by the insurance company. He said that when a provider orders a medication, especially one that is only available as a name-brand drug, it must go through the insurer’s review and prior authorization process. If the insurance company determines that a medically equivalent generic is available, it will not approve coverage for the name-brand medication.
Megan Egbert — Representative Egbert thanked the witness and first asked whether they had encountered others struggling with copay accumulators. He then followed up by asking how Idaho Code 41-348 applies to the bill, expressing uncertainty that the provision seems aimed at service providers and questioning whether the issue involves a kickback.
Megan Egbert — Called during roll call; vote not clearly captured in transcript fragment.
Megan Egbert — Spoke to the motion after Representative Kaler.
Steve Thomas — Steve Thomas testified for the Association of Idaho Health Plans, describing it as the four largest carriers in Idaho that collectively insure hundreds of thousands of residents and operate as not-for-profits. He explained that any savings are passed on to insureds and noted that prescription drugs are a major component of health care spending. Thomas then opposed the bill, arguing it would increase costs for insureds and that deductibles and other out-of-pocket costs help control spending by giving consumers some skin in the game. He expressed sympathy for the Drollinger family but said the association’s position is based on keeping costs down for all insureds, and added that Medicare and Medicaid prohibit the practice as an improper kickback.
Steven Tanner — Representative Tanner asked whether insurers might respond to the bill by raising deductibles or out-of-pocket costs, drawing an analogy to how federal involvement in student loans affected pricing. Mr. Thomas responded that insurance companies compete, addressing Tanner’s concern about deductible changes.
Steven Tanner — Representative Steven Tanner said he was conflicted about the bill and appreciated the sponsors, but worried the insurance industry might respond by raising deductibles or otherwise shifting costs back onto providers or drug manufacturers. He ultimately could not support the bill and was recorded as voting no.
Steven Tanner — Representative Tanner questions the logic of using a prior authorization exemption as a reward for taking on preceptorship responsibility, and the point is then addressed in the explanation of the incentive mechanism.
Mr. Thomas — Mr. Thomas responds to questions about deductible and out-of-pocket changes by explaining that insurance companies compete on the overall benefit package, so richer benefits and lower deductibles trade off against each other. He says he cannot isolate the pharmaceutical benefit alone because actuaries set rates based on projected use across the entire package of benefits. He then adds that he had only recently learned about the statute being discussed and argues that practices like coupons or kickbacks distort the stated price of a drug transaction, making the listed price different from the real price.
Tristan Drollinger — Named as the next virtual witness, though the committee notes a discrepancy with the name Trevor.
Trevor — The committee discusses whether the witness is Trevor or Tristan due to a naming discrepancy.
Trevor Jollinger — Trevor Jollinger testifies in support of House Bill 713, explaining that patient assistance has helped his family avoid costly hospitalizations and access needed medication at home. He argues that allowing patient assistance to count toward cost-sharing encourages routine preventive care and reduces emergency care, supports banning copay accumulators, and says the bill will not affect Idaho’s budget.
Brittany Shipley — Called next, but the chair notes she is for a different bill.
Brittany Shipley — Brittany Shipley testifies in support of the bill, introducing herself and explaining that she is speaking for herself and her child, who was placed in residential care and suffered serious abuse. She clarifies that these children were not foster children or wards of the state, but were their own children placed in high-level psychiatric residential treatment because they could not safely remain at home. She describes delays in finding placement, the abuse that occurred once her child was admitted, and the oversight gaps highlighted by the OPE report. She argues that parents often do not know about abuse and children may be unable to report it, so the bill is needed as a safeguard for children and families. She also notes that the children’s ombudsman system does not cover children placed through Medicaid, Magellan, or developmental disability agencies.
Rob Beiswenger — Expressed appreciation for the bill but said he struggles with more government involvement in medical billing and costs.
Rob Beiswenger — Praised as a co-sponsor bringing the legislation forward.