SB665: (New Title) relative to pharmacy benefits managers, managed care laws, notice of drug pricing options and pharmacy benefit manager business practices.

Related law links

RSA references from bill data

• 318 · amend · effective 2027-01-01

  s used to compensate the pharmacy benefits manager. VII. Nothing in this section shall prohibit the use of spread pricing. 13 New Subdivision; Drug Pricing Options. Amend RSA 318 by inserting after section 47-m the following new subdivision: Drug Pricing Options 318:47-n Notice of Drug Pricing Options. I. Every pharmacy licensed in this state shall make reasonable efforts to notify cons

• 400-A:16 · reference · effective 2027-01-01

  sioner may directly bill a pharmacy benefits manager for the costs of any examination. II. The commissioner may investigate the acts of a pharmacy benefits manager pursuant to RSA 400-A:16. III. The pharmacy benefits manager shall make all records and books of account available to the examiners or consultants and shall otherwise facilitate the performance of the examination or investigation. 6 New

• 400-A:37 · reference · effective 2027-01-01

  manager shall be considered the acts of the health carrier on whose behalf it is acting. A pharmacy benefits manager may be examined as if it were the health carrier pursuant to RSA 400-A:37 and the commissioner may directly bill a pharmacy benefits manager for the costs of any examination. II. The commissioner may investigate the acts of a pharmacy benefits manager pursuant to RSA 400-A:16. III. Th

• 402-N · amend · effective 2027-01-01

  -compliance shall be considered a separate violation. (b) Revocation or suspension of the pharmacy benefits manager registration. 3 New Section; Written Agreements. Amend RSA 402-N by inserting after section 2 the following new section: 402-N:2-a. Written Agreement. I. No pharmacy benefits manager shall act as such without a written agreement between the pharmacy benefits manager and the h

• 402-N:1 · amend · effective 2027-01-01

  and notice of drug pricing options. Be it Enacted by the Senate and House of Representatives in General Court convened: 1 Pharmacy Benefits Managers; Definitions. Amend RSA 402-N:1, VIII to read as follows: VIII.(a) "Pharmacy benefits manager" means a person, business, or other entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefits manager or licensed hea

• 402-N:2 · amend · effective 2027-01-01

  ary is providing pharmacy benefits management services exclusively to its own insureds.] 2 Pharmacy Benefits Managers; Registration to do Business; Rulemaking; Penalties. Amend RSA 402-N:2, III to read as follows: III. If the commissioner finds after notice and hearing that any person has violated any provision of this chapter, or [rules adopted pursuant to this chapter] insurance laws of this state,

• 402-N:6 · repeal · effective 2027-01-01

  e health carrier shall, at least semi-annually, conduct an on-site or virtual audit of the operations of the pharmacy benefits manager. 4 Pharmacy Benefits Manager Reporting. RSA 402-N:6 is repealed and reenacted to read as follows: 402-N:6 Pharmacy Benefits Manager Reporting. I. Each pharmacy benefits manager shall submit to the commissioner semi-annually a report containing a list of health be

• 402-N:7 · repeal · effective 2027-01-01

  any other plan outside the jurisdiction of the commissioner. 5 Pharmacy Benefits Managers; Authority to Examine and Directly Bill Pharmacy Benefits Managers for Examinations. RSA 402-N:7 is repealed and reenacted to read as follows: 402-N:7 Authority to Examine and Directly Bill Pharmacy Benefits Managers for Examinations. I. The acts of the pharmacy benefits manager shall be considered the acts

• 415-A:7 · amend · effective 2027-01-01

  ccur only after the appeal and external review process has concluded. 10 New Subparagraphs; Standards for Accident and Health Insurance; Establishing Excess Cost Sharing. Amend RSA 415-A:7, I by inserting after subparagraph (b) the following new subparagraphs: (c) “Pharmacy benefits manager” means “pharmacy benefits manager” as defined in RSA 402-N:1, VIII. (d) “Spread pricing” means the model of drug

• 420-G:2 · reference · effective 2027-01-01

  icensed health insurer, that, pursuant to a contract with a health carrier, manages the prescription drug coverage provided by the health carrier for health coverage as defined in RSA 420-G:2, IX, including, but not limited to, providing claims processing services for prescription drugs, performing drug utilization review, processing drug prior authorization requests, adjudication of grievances or appeals re

• 420-J · reference · effective 2027-01-01

  pharmacy or pharmacist to reverse and rebill the claim in question. (3) All claims adjudications, appeals, and utilization review processes shall comply with the requirements of RSA 420-J and rules promulgated thereunder. (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 p

• 420-J:7-B · amend · effective 2027-01-01

  cycle. A pharmacy that requests an additional 7 days prior to the commencement of an audit shall be granted 7 additional days. 8 Managed Care Law; Prescription Drugs. Amend RSA 420-J:7-b, III-IV to read as follows: III. Every health plan that provides prescription drug benefits shall provide written notice in a conspicuous font and size to covered persons affected by deletions to the plan list or pl

• 420-J:8 · amend · effective 2027-01-01

  state to the maximum extent permitted by federal law, consistent with prevailing United States Supreme Court precedent. 7 Managed Care Law; Provider Contract 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 prod

• 420-J:8-B · amend · effective 2027-01-01

  date the maximum allowable cost list was changed and when impacted pharmacies were notified of the change. 9 Managed Care Law; Retroactive Denials Prohibited; Exceptions. Amend RSA 420-J:8-b, III to read as follows: III. A health carrier shall notify a health care provider at least 15 days in advance of the imposition of any retroactive denials of previously paid claims. The health care provider shall

• 541-A · reference · effective 2027-01-01

  format of the report and procedure for filing the report. Any forms, templates, or guidance regarding the report required by the section shall be exempt from the requirements of RSA 541-A. IV. This section shall not apply to data related to Medicaid, the Medicaid Care Management program, the Ryan White HIV/AIDS program administered by the department of health and human services, self-funded plans, the

• 91-A · reference · effective 2027-01-01

  section shall be confidential and protected from disclosure under the commissioner's examination authority and shall not be considered a public record subject to disclosure under RSA 91-A. Based on this reporting, the commissioner shall make public aggregated data on the overall amount of rebates collected on behalf of covered persons in the state, but shall not release data that identifies a specific h

RSAs mentioned by this document

• RSA 91-A · ACCESS TO GOVERNMENTAL RECORDS AND MEETINGS
• RSA 318 · PHARMACISTS AND PHARMACIES
• RSA 400-A · INSURANCE DEPARTMENT
• RSA 402-N · PHARMACY BENEFITS MANAGERS
• RSA 415-A · STANDARDS FOR ACCIDENT AND HEALTH INSURANCE
• RSA 420-G · PORTABILITY, AVAILABILITY, AND RENEWABILITY OF HEALTH COVERAGE
• RSA 420-J · MANAGED CARE LAW
• RSA 541-A · ADMINISTRATIVE PROCEDURE ACT
• RSA 400-A:16 · Investigations, Enforcement
• RSA 400-A:37 · Examinations
• RSA 402-N:1 · Definitions
• RSA 402-N:2 · Registration to do Business; Rulemaking; Penalties
• RSA 402-N:6 · Pharmacy Benefits Manager Reporting
• RSA 402-N:7 · Authority to Examine and Directly Bill Pharmacy Benefits Managers for Certain Examinations
• RSA 415-A:7 · Establishing Excess Cost Sharing
• RSA 420-G:2 · Definitions
• RSA 420-J:8 · Provider Contract Standards