SB 128-FN - AS INTRODUCED
2015 SESSION
15-0941
01/09
SENATE BILL 128-FN
AN ACT relative to pharmacy benefit managers paying claims.
SPONSORS: Sen. Cataldo, Dist 6
This bill establishes certain procedures for pharmacy benefit managers when paying claims.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
15-0941
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fifteen
AN ACT relative to pharmacy benefit managers paying claims.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Pharmacy Benefit Managers; Claims. Amend RSA 420-J by inserting after section 7-d the following new section:
420-J:7-e Pharmacy Benefit Managers; Claims. A pharmacy benefit manager or other entity paying pharmacy claims shall not:
I. Impose a higher copayment for a prescription drug than the copayment applicable to the type of drug purchased under the insurer’s health benefit plan.
II. Impose a higher copayment for a prescription drug than the maximum allowable cost for the drug.
III. Require a pharmacy to pass any portion of the insured’s copayment to the pharmacy benefit manager or other payer.
2 Effective Date. This act shall take effect 60 days after its passage.
LBAO
15-0941
1/15/15
SB 128-FN - FISCAL NOTE
AN ACT relative to pharmacy benefit managers paying claims.
FISCAL IMPACT:
The Insurance Department states this bill, as introduced, may have an indeterminable impact on state revenue in FY 2016 and in each year thereafter. There will be no fiscal impact on county or local revenue or on state, county, and local expenditures.
METHODOLOGY:
The Insurance Department states this bill would limit higher copays in certain instances for drugs covered by insurance plans and prohibit Pharmacy Benefit Managers (PBMs) from requiring participating pharmacies to share copay revenue. The Department assumes this bill could increase premiums and, as a result, increase state premium tax revenue. However, the Department also indicates it may not increase premiums if purchasers of insurance buy lower cost insurance to avoid a price increase.
The Department of Health and Human Services states if the bill becomes law, it may apply to Medicaid Care Management. The Department indicates copayments for Medicaid pharmacy are only $1-$4 and at these low rates it is unlikely that any of the provisions would be triggered. The Department indicates no fiscal impact is anticipated from this bill.