HB517 (2007) Detail

(2nd New Title) establishing a commission to investigate cost drivers in providing health care and establishing the New Hampshire Rx advantage program and continually appropriating a special fund and making an appropriation therefor.


CHAPTER 297

HB 517 – FINAL VERSION

05/24/07 1670s

06/07/07 2039s

13Jun2007… 2313eba

2007 SESSION

07-0360

01/05

HOUSE BILL 517

AN ACT establishing a commission to investigate cost drivers in providing health care and establishing the New Hampshire Rx advantage program and continually appropriating a special fund and making an appropriation therefor.

SPONSORS: Rep. MacKay, Merr 11; Rep. Rosenwald, Hills 22; Rep. McLeod, Graf 2; Sen. Hassan, Dist 23; Sen. Sgambati, Dist 4; Sen. Fuller Clark, Dist 24

COMMITTEE: Health, Human Services and Elderly Affairs

AMENDED ANALYSIS

This bill establishes a commission to investigate cost drivers in providing health care.

This bill also establishes the New Hampshire Rx advantage program for prescription drugs. Under this program, participating pharmacies shall sell prescription drugs to qualified residents at a discounted price. The bill grants rulemaking authority to the New Hampshire pharmacy board and the commissioner of the department of health and human services for the purposes of the program. The bill makes an appropriation for the purposes of the program.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

05/24/07 1670s

06/07/07 2039s

13Jun2007… 2313eba

07-0360

01/05

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Seven

AN ACT establishing a commission to investigate cost drivers in providing health care and establishing the New Hampshire Rx advantage program and continually appropriating a special fund and making an appropriation therefor.

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

297:1 Commission Established. There is established a commission to investigate cost drivers in providing health care.

297:2 Membership and Compensation.

I. The members of the commission shall be as follows:

(a) Three members of the house of representatives, one of whom shall be a member of the house committee on health, human services and elderly affairs, and one of whom shall be a member of the house commerce committee, appointed by the speaker of the house of representatives.

(b) Two members of the senate, appointed by the president of the senate.

(c) The commissioner of the department of health and human services, or designee.

(d) The insurance commissioner, or designee.

(e) One member of the Endowment for Health, Inc., appointed by such organization.

(f) One member of the Business and Industry Association of New Hampshire, appointed by such association.

(g) A representative of the insurance industry, appointed by the governor.

(h) One member of the New Hampshire Hospital Association, appointed by such association.

(i) One member of the New Hampshire Medical Society, appointed by such society.

(j) One member of the New Hampshire Trial Lawyers Association, appointed by such association.

(k) Three members of chambers of commerce, one appointed by the speaker of the house of representatives, one appointed by the president of the senate, and one appointed by the governor, all appointed in a manner to provide diverse geographical representation.

(l) A representative of Dartmouth-Hitchcock Medical Center, appointed by the center.

(m) The director of the New Hampshire Institute of Health Policy and Practice at the university of New Hampshire.

(n) One member of the Retail Merchants Association of New Hampshire, appointed by such association.

II. Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission.

297:3 Duties. The commission shall review and study health care cost drivers including, but not limited to:

I. Cost shifting associated with federal and state reimbursements.

II. Cost shifting associated with providing care for the uninsured.

III. Costs associated with medical malpractice insurance rates.

IV. Regional issues that may affect costs of providing health care.

V. Hospital new construction costs and overhead costs for the past 5 years.

VI. Hospital new services and overhead costs for the past 5 years.

VII. Other areas that may affect the cost of providing health care.

297:4 Chairperson; Quorum. The members of the commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named house member. The first meeting of the commission shall be held within 45 days of the effective date of this section. Seven members of the commission shall constitute a quorum.

297:5 Report. The commission shall report its findings and any recommendations for proposed legislation to the speaker of the house of representatives, the president of the senate, the house clerk, the senate clerk, the governor, and the state library on or before November 1, 2007.

297:6 Statement of Purpose. The general court finds that affordability is critical in providing access to prescription drugs for New Hampshire residents. Therefore, the general court hereby establishes the New Hampshire Rx advantage program for qualified New Hampshire residents, thereby increasing the overall health of New Hampshire residents, promoting healthy communities, and protecting the public health and welfare. It is the intent of this act to integrate the New Hampshire Rx advantage program as part of any statewide program for the uninsured and to have consumers self-qualify for the program. It is not the intent of sections 6-10 of this act to discourage employers from offering or paying for prescription drug benefits for their employees or to replace employer-sponsored prescription drug benefit plans that provide benefits comparable to those made available to qualified New Hampshire residents under this act. The New Hampshire Rx advantage program is also not intended to address past cuts in dispensing fees.

297:7 New Chapter; New Hampshire Rx Advantage Program. Amend RSA by inserting after chapter 161-K the following new chapter:

CHAPTER 161-L

NEW HAMPSHIRE RX ADVANTAGE PROGRAM

161-L:1 Definitions. In this chapter:

I. “Commissioner” means the commissioner of the department of health and human services.

II. “Covered drugs” means drugs that are on the New Hampshire preferred drug list.

III. “Department” means the department of health and human services.

IV. “Dispensing fee” means a fee for each prescription dispensed by a pharmacy that is paid to the pharmacy.

V. “Fund” means the New Hampshire Rx advantage program fund, established in RSA¬†161-L:5.

VI. “Initial discounted price” for a drug means the price which has been discounted from a pharmacy’s usual and customary charge that participating retail pharmacies may charge qualified residents participating in the program for that drug.

VII. “Labeler” means an entity or person that receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale and that has a labeler code from the federal Food and Drug Administration under 21 C.F.R. section 207.20.

VIII. “Participating retail pharmacy” or “retail pharmacy” means a retail pharmacy located in this state, or another business licensed to dispense prescription drugs in this state, that participates in the program.

IX. “Program” means the New Hampshire Rx advantage program established under this chapter.

X. “Qualified resident” means a resident of this state who has a family income equal to or less than 300 percent of the federal poverty level and who self-qualifies as an enrollee in the program. “Qualified resident” also means a resident of this state whose family incurs unreimbursed expenses for prescription drugs that equal 5 percent or more of family income or whose total unreimbursed medical expenses equal 15 percent or more of family income. For purposes of this definition, the cost of drugs provided under this chapter shall be considered an expense incurred by the family for eligibility determination purposes.

XI. “Secondary discounted price” means the initial discounted price minus any further discounts paid for out of the fund.

XII. “Usual and customary charge” means the charge a pharmacy charges a customer for a prescription drug.

161-L:2 New Hampshire Rx Advantage Program Established. The department shall establish the New Hampshire Rx advantage program. The department may coordinate this program with other programs and may take actions to enhance efficiency, reduce the cost of prescription drugs, and maximize the benefits to the programs and enrollees, including providing the benefits of this program to enrollees in other programs. The components of the program shall be as follows:

I. A drug manufacturer or labeler that sells prescription drugs in this state through any other publicly-supported pharmaceutical assistance program may enter into a rebate agreement with the department for this program. The rebate agreement shall require the manufacturer or labeler to make rebate payments to the state each calendar quarter or according to a schedule established by the department.

II. The commissioner shall negotiate the amount of the rebate required from a manufacturer or labeler in accordance with this paragraph.

(a) The commissioner shall take into consideration the rebate calculated under the Medicaid Rebate Program pursuant to 42 U.S.C. section 1396r-8, the average wholesale price of prescription drugs, and any other information on prescription drug prices and price discounts.

(b) The commissioner shall use the commissioner’s best efforts to obtain an initial rebate amount equal to or greater than the rebate calculated under rebates pursuant to 42 U.S.C. section 1396r-8.

(c) With respect to the rebate taking effect no later than October 1, 2009, the commissioner shall use the commissioner’s best efforts to obtain an amount equal to or greater than the amount of any discount, rebate, or price reduction for prescription drugs provided to the federal government.

III. Each participating retail pharmacy shall sell covered drugs to qualified residents at the lower of the initial discounted price and the secondary discounted price as such prices are determined by the department pursuant to this chapter.

(a) The department shall establish discounted prices for drugs covered by a rebate agreement and shall promote the use of efficacious and reduced-cost drugs, taking into consideration reduced prices for state and federally-capped drug programs, differential dispensing fees, administrative overhead, and incentive payments.

(b) Beginning July 1, 2008, a participating retail pharmacy shall offer the initial discounted price.

(c) No later than October 1, 2009, a participating retail pharmacy shall offer the secondary discounted price if available.

161-L:3 Retail Pharmacies; Rules; Operation of Program.

I. The New Hampshire pharmacy board, established in RSA 318, shall adopt rules, pursuant to RSA 541-A, requiring disclosure by participating retail pharmacies to qualified residents relative to the amount of savings provided as a result of the program. The rules shall include protection of any information that is proprietary in nature.

II. The department shall not impose transaction charges under this program on retail pharmacies that submit claims or receive payments under the program.

III. A participating retail pharmacy shall submit claims to the department to verify the amount charged to qualified residents.

IV. On a weekly or biweekly basis, the department shall reimburse a participating retail pharmacy for the difference between the initial discounted price and the secondary discounted price provided to qualified residents under the program.

V. The department shall conduct ongoing quality assurance activities.

VI. The commissioner shall negotiate a per prescription dispensing fee which shall not be less than the medicaid dispensing fee to be paid to participating pharmacies.

161-L:4 Nonparticipating Manufacturers and Labelers.

I. The names of manufacturers and labelers who do and do not enter into rebate agreements pursuant to this chapter shall be public information. The department shall release such information to health care providers and the public on a regular basis and shall publicize participation by manufacturers and labelers that is of particular benefit to the public.

II. The department may impose prior authorization requirements in the program, as permitted by law, to the extent the department determines it is appropriate to do so in order to encourage manufacturer and labeler participation in the program and if the additional prior authorization requirements remain consistent with the goals of the program and the requirements of the federal Social Security Act, Title XIX.

161-L:5 New Hampshire Rx Advantage Program Fund. There is hereby established in the office of the state treasurer a fund to be known as the New Hampshire Rx advantage program fund. The fund shall receive revenue from manufacturers and labelers who pay rebates as provided in 161-L:2, II and any appropriations or allocations designated for the fund. The purposes of the fund shall include, but not be limited to reimbursing retail pharmacies for discounted prices provided to qualified residents; reimbursing the department for contracted services including pharmacy claims processing fees, administrative and associated computer costs, and other reasonable program costs; and benefiting any state sanctioned low cost drug program subsequently established. Moneys in the fund shall be nonlapsing and continually appropriated to the department. Interest on fund balances shall accrue to the fund. Surplus funds in the fund shall be used for the benefit of the program.

161-L:6 Rulemaking. The commissioner shall adopt rules pursuant to RSA 541-A, relative to:

I. Procedures for issuing program enrollment cards.

II. Outreach efforts to build public awareness of the program and to maximize enrollment of eligible residents.

III. Content and format of any forms required under this chapter.

IV. Procedures for entering into rebate agreements with drug manufacturers or labelers.

V. Manner of releasing information to the public under RSA 161-L:4.

161-L:7 Annual Report Required. The commissioner shall make an annual report beginning January 1, 2009 relative to the enrollment and financial status of the program, including any recommendations for legislation, to the speaker of the house of representatives, the president of the senate, and the governor.

297:8 Generic Drugs. Amend RSA 126-A:3, V to read as follows:

V. Pharmacists shall substitute generically equivalent drug products for all legend and non-legend prescriptions paid for by the department of health and human services, including the medicaid program, unless the prescribing practitioner specifies that the brand name drug product is medically necessary. Such notification shall be in the practitioner’s own handwriting and shall be retained in the pharmacist’s file. [The commissioner may waive the application of RSA 126-A:3, III if the commissioner determines such action is necessary to ensure the availability of prescription and other pharmaceutical services to persons served by the department or to avert serious economic hardship in the provision of prescriptions and other pharmaceutical services. The commissioner shall adopt rules under RSA 541-A relative to a waiver of the application.] The provisions of paragraph III shall not apply to the dispensing by a pharmacy for medical assistance reimbursement for legend and non-legend drugs. The commissioner, in consultation with pharmacy providers, [may develop a new methodology for] shall establish medical assistance reimbursement for legend and non-legend drugs.

297:9 New Paragraph; Pharmacy Board; Rulemaking. Amend RSA 318:5-a by inserting after paragraph XVII the following new paragraph:

XVIII. Disclosure and confidentiality relative to the New Hampshire Rx advantage program, pursuant to RSA 161-L:3.

297:10 New Subparagraph; New Hampshire Rx Advantage Program Fund. Amend RSA 6:12, I(b) by inserting after subparagraph (252) the following new subparagraph:

(253) Moneys deposited in the New Hampshire Rx advantage program fund pursuant to RSA 161-L:5.

297:11 Appropriation. The sum of $1 for the fiscal year ending June 30, 2008 and the sum of $1 for fiscal year ending June 30, 2009 are hereby appropriated to the department of health and human services for the purposes of sections 6-10 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

297:12 Effective Date.

I. RSA 161-L:4, II as inserted by section 7 of this act shall take effect July 1, 2010.

II. Except as provided in paragraph I, sections 6-10 of this act shall take effect January 1, 2008.

III. The remainder of this act shall take effect upon its passage.

Approved: July 13, 2007

Effective: I. RSA 161-L:4, II as inserted by section 7 shall take effect July 1, 2010.

II. Except as provided in paragraph I, sections 6-10 shall take effect January 1, 2008.

III. Remainder shall take effect July 13, 2007.

Links

HB517 at GenCourtMobile

Action Dates

Date Body Type

Bill Text Revisions

HB517 Revision: 10765 Date: Jan. 11, 2010, midnight

Docket