Insurance director: PBM complaints, 1332 waiver and wildfire pressures shaping Idaho insurance policy

BOISE — Dean Cameron, director of the Idaho Department of Insurance, told the Joint Finance-Appropriations Committee on Tuesday that the department is implementing new pharmacy benefit manager (PBM) reporting and complaint processes, administering a high‑risk reinsurance pool supported by a Section 1332 waiver, and monitoring wildfire-driven disruptions in the homeowners insurance market.

The department presented its FY2026 enhancement requests and reviewed funding sources, staffing and recent workload. Noah Peterson, the Legislative Services Office analyst, said the department has 75.5 approved full‑time positions and that its two dedicated funds (the Arson, Fire and Fraud Prevention Fund and the Insurance Administrative Fund) support regulation and the state fire marshal program.

PBM oversight and complaints: Cameron said the department hired an analyst to implement requirements from last year’s pharmacy benefit manager reform and to collect PBM data. “She's receiving numerous complaints,” Cameron said, and the department has required PBMs to submit data in a prescribed format; most have complied while a few remain in outreach. He told the committee the complaint caseload ranges across issues from dispensing fees and payment to contract disputes and responsiveness.

High‑risk pool and Section 1332 waiver: Cameron credited the state’s 1332 waiver and the high‑risk pool with lowering individual market rates and increasing carrier participation on Idaho’s exchange. He said the high‑risk pool functions like reinsurance, identifying expensive risks by CPT code and sharing claims costs to help stabilize premiums.

Wildfire and homeowners insurance pressure: Cameron told the committee that wildfire risks and national reinsurance market tightening have affected Idaho, and that carriers have tightened writing in fire‑prone areas. “This last year we burned a million acres, just under a million acres,” Cameron said; he described a rise in nonrenewals and expansion of the surplus‑lines market (nonadmitted policies) for homeowners coverage. The department plans legislation to create a mitigation and reinsurance‑style pool that would help homeowners harden properties and assist carriers in spreading risk.

Budget and staffing requests: the department requested four enhancement items for FY2026 including a staff actuary (1 FTE, $201,900 ongoing) for actuarial rate reviews, a regulatory compliance specialist, compensation increases for the state fire marshal and deputies ($48,100 ongoing), and one‑time capital‑outlay replacements including turnout gear and two pickup trucks ($162,200 one time). Peterson reported that in FY2024 the agency reverted about $2.2 million of its appropriation (split between personnel and operating dollars).

Statutory implementation: Peterson noted the department received a trailer appropriation to implement House Bill 596, which amended Idaho Code section 41‑349 to revise definitions and reporting requirements for pharmacy benefit managers; the department was appropriated 1 FTE and $132,400 for that purpose.

Committee follow-up and context: Senators asked for complaint counts and compliance metrics for PBM oversight; Cameron said the program is workload‑intensive and that the new analyst is handling numerous submissions and complaints. He also described broader market trends: carriers buy reinsurance and changes in reinsurance pricing and catastrophic losses elsewhere have tightened capacity and driven some carriers away from parts of the market. Cameron said the department is working on proposals to help homeowners mitigate fire risk and to maintain market access while balancing consumer protections.

Cameron introduced senior staff in the hearing and said the department is largely staffed, noting that most employees work on site with only a small portion telecommuting for health reasons. He thanked the committee for prior support and said the department will provide more detailed PBM complaint and data reports as they collect and reconcile filings.