New Hampshire SB 247: preventing childhood lead poisoning from paint and water and making an appropriation to a special fund.

Bill Text

SB 247 - AS AMENDED BY THE SENATE

03/27/2025 1401s

2025 SESSION

 25-0984

 05/11

SENATE BILL 247

AN ACT prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.

SPONSORS: Sen. Rochefort, Dist 1; Sen. Avard, Dist 12; Sen. Innis, Dist 7; Rep. Cole, Hills. 26; Rep. Spier, Hills. 6

COMMITTEE: Health and Human Services

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AMENDED ANALYSIS

 This bill:

 I. Permits a pharmacy to decline to fill a prescription if reimbursement from the pharmacy benefits manager is less than the pharmacy's acquisition cost and excludes Medicaid and Medicaid care management from this option and other provider contract standards.

 II. Defines pharmacy services administrative organization for purposes of pharmacy and PBM contract requirements; and makes the failure of a pharmacy services administrative organization to comply with such requirements a violation of the consumer protection act.

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Explanation: Matter added to current law appears in bold italics.

 Matter removed from current law appears [in brackets and struckthrough.]

 Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/27/2025 1401s 25-0984

 05/11

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty Five

AN ACT prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.

Be it Enacted by the Senate and House of Representatives in General Court convened:

 1 Managed Care Law; Pharmacy and Pharmacist Contracting Standards. Amend RSA 420-J:8, XV to read as follows:

 XV.(a) All contracts between a carrier or pharmacy benefit manager and a contracted pharmacy shall include:

 (1) The sources used by the pharmacy benefit manager to calculate the drug product reimbursement paid for covered drugs available under the pharmacy health benefit plan administered by the carrier or pharmacy benefit manager.

 (2) A process to appeal, investigate, and resolve disputes regarding the maximum allowable cost pricing. The process shall include the following provisions:

 (A) A provision granting the contracted pharmacy or pharmacist at least 30 business days following the initial claim to file an appeal;

 (B) A provision requiring the carrier or pharmacy benefit manager to investigate and resolve the appeal within 30 business days;

 (C) A provision requiring that, if the appeal is denied, the carrier or pharmacy benefit manager shall:

 (i) Provide the reason for the denial; and

 (ii) Identify the national drug code of a drug product that may be purchased by contracted pharmacies at a price at or below the maximum allowable cost; and

 (D) A provision requiring that, if an appeal is granted, the carrier or pharmacy benefits manager shall within 30 business days after granting the appeal:

 (i) Make the change in the maximum allowable cost; and

 (ii) Permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question.

 (b) For every drug for which the health carrier or pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the health carrier or pharmacy benefit manager shall:

 (1) Include in the contract with the pharmacy information identifying the national drug pricing compendia or sources used to obtain the drug price data.

 (2) Make available to a contracted pharmacy the actual maximum allowable cost for each drug.

 (3) Review and make necessary adjustments to the maximum allowable cost for every drug for which the price has changed at least every 14 days.

 (c) [Repealed.]

 (d) [Repealed.]

 (e) A pharmacist or pharmacy in a network plan with a health carrier or pharmacy benefits manager may decline to provide a brand-name drug, multi-source generic drug, supply, or service if the reimbursement amount is less than the acquisition cost paid by the pharmacy or pharmacist. If a pharmacist or pharmacy declines to provide the prescription or service, the pharmacy or pharmacist shall advise the patient to contact the health carrier or pharmacy benefits manager using the contact information on the prescription drug card for information as to where the prescription for the drug, supply, or service may be filled.

 2 New Paragraph; Managed Care Law; Provider Contract Standards; Medicaid Exclusion. Amend RSA 420-J:8 by inserting after paragraph XVIII the following new paragraph:

 XIX. Nothing in this section shall be construed to apply to Medicaid or Medicaid care management.

 3 New Paragraph; Regulation of Business Practices for Consumer Protection; Pharmacy Services Administrative Organizations. Amend RSA 358-A:2 by inserting after paragrap