This newsletter is an attempt to share a few interesting — and hopefully useful — tidbits of information from across Idaho health care and health policy. Typically, I’ve found successful health care executives or health policy leaders are usually deeply knowledgeable about their silo. Maybe even the silo adjacent to them.
So, we try to offer content and a conference that brings together as many of the silos as possible. It creates something like a “network effect” where some of the value comes in the sharing. So, thanks to the folks who helped shape this newsletter — and those already at work to shape our upcoming conference!
— DJ Wilson
Sen. Julie VanOrden chairs the Senate Health and Welfare Committee. With significant turnover in the House H&W Committee, it means VanOrden will play an even more important role in health policy in next year’s session as she brings her institutional knowledge to policy making.
She joined us for an interview recently where she discussed the extensive work the Medicaid Review Panel (which she co-chairs) has been doing in preparation for Medicaid managed care. “In the end, this will be the biggest contract the state has ever procured. And the legislature will have been involved from beginning to end on this, which has never happened in our state before.” The Panel’s next public meeting is Thursday Sept. 24th.
At yesterday’s Health Insurers Working Group, committee staff released data showing the MLR for some health plans in Idaho ranged from 82% at the St. Luke’s Health Plan to Moda’s 108%. The lower the number, the more likely the plan will be profitable.
Three provider organization also shared their operational margins. Each entity showed margins that were in decline since 2021.
Navitus, a pharmacy benefit manager (PBM) had been paying dispensing fees to some Idaho pharmacies of $0.40 per event. Sometimes, they paid amounts equal to $0.00. Under a new law in effect in since January 2025, in-network pharmacies must now be paid dispensing fees that reasonably cover their costs.
Under an Order issued last week from the DOI, Navitus must pay dispensing fees of $11.50 on a “go-forward” basis. It must also re-adjudicate claims from January 2025, and retroactively pay no less than $9.00 per event. A recent DOI study said the cost to dispense drugs was about $12.26. Notably, this is the third recent administrative action by DOI against PBMs after orders against OptumRx and Express Scripts.
The Meridian City Council was a flash point in health policy last week. It denied a motion by “micro-hospital” operator Nutex Health to open a facility there. Nutex has been the focus of concerns about the unintended consequences of the “No Surprises Act” and out-of-network billing through the arbitration process.
Ultimately, the City Council — which included Councilmember Brian Whitlock, the CEO of the Idaho Hospital Association — unanimously denied a request by Nutex to allow what it said was the same hospital access allowance that St. Luke Meridian has. The Idaho Association of Health Plans submitted a 12-page letter of concerns, and Blue Cross VP of Public Affairs Mike Reynoldson appeared personally to voice BCI opposition. Who knows what’s next in this process, but here is some unsolicited advice, Nutex: become a member of the IHA.
As we develop the 2026 Idaho Health Policy Commons conference agenda, I’ve had a chance to learn from many of Idaho’s senior health care executives and health policy leaders about what is on their minds. Our Convening Panel met recently, and I continue to have one on one conversations with folks throughout Idaho. We put this all into our Topical Agenda, which we’ll release in a few weeks.
For a sense of what folks are telling me, check out our Discussion Guide from our recent Convening Panel get together. Page 4 is a reflection of what I’ve been hearing from folks that they’d like to see on our December 8th agenda. If you see something important that’s missing, let me know. I’d appreciate hearing from you as we build this out, as well.
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