HB 584 – VERSION ADOPTED BY BOTH BODIES
8Jan2014… 0600h
2013 SESSION
01/09
HOUSE BILL 584
AN ACT relative to covered prescription drugs.
SPONSORS: Rep. Rosenwald, Hills 30; Rep. M. MacKay, Hills 30; Rep. D. McGuire, Merr 21; Rep. Kurk, Hills 2; Sen. Reagan, Dist 17; Sen. Lasky, Dist 13; Sen. Gilmour, Dist?12
COMMITTEE: Health, Human Services and Elderly Affairs
This bill requires insurers to allow covered persons to purchase their 90-day supply of covered prescription drugs at the pharmacy of their choice.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
8Jan2014… 0600h
13-0523
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to covered prescription drugs.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Covered Prescription Drugs. Amend RSA 415:6-aa to read as follows:
415:6-aa 90-Day Supply of Covered Prescription Drugs. An insurer issuing or renewing accident and health insurance policies shall allow its insureds to purchase an up-to-90-day supply of covered prescription drugs on the covered person’s health plan formulary at one time at a pharmacy of the insured’s choice within the insurer’s network, provided that the insured can demonstrate that such drug has been taken by the insured for a continuous period of one year and provided that such drug is not subject to the health plan’s utilization management, prior authorization, or pre-certification requirements. Controlled substances as identified by the United States Drug Enforcement Administration are exempt from this section. Nothing in this section shall be construed to limit the health plan’s ability to establish co-payments, coinsurance deductibles, or other member cost shares. A retail pharmacy dispensing a 90-day supply of covered prescription drugs under this section shall comply with any specified terms, conditions, and [price] reimbursement rate which the plan may require for mail order pharmacies that fill 90-day prescriptions.
2 Covered Prescription Drugs; Managed Care. Amend RSA 420-J:7-b, VIII to read as follows:
VIII. Every health benefit plan that provides prescription drug benefits shall allow its covered persons to purchase an up-to-90-day supply of covered prescription drugs on the covered person’s health benefit plan formulary at one time at a pharmacy of the insured’s choice within the insurer’s network, provided that the insured can demonstrate that such drug has been taken by the insured for a continuous period of one year and provided that such drug is not subject to the health benefit plan’s utilization management, prior authorization, or pre-certification requirements. Controlled substances as identified by the United States Drug Enforcement Administration are exempt from this paragraph. Nothing in this paragraph shall be construed to limit the health benefit plan’s ability to establish co-payments, coinsurance deductibles, or other member cost shares. A retail pharmacy dispensing a 90-day supply of covered prescription drugs under this paragraph shall comply with any specified terms, conditions, and [price] reimbursement rate which the health benefit plan may require for mail order pharmacies that fill 90-day prescriptions
3 Effective Date. This act shall take effect 60 days after its passage.
LBAO
13-0523
Amended 02/03/14
HB 584 FISCAL NOTE
AN ACT relative to covered prescription drugs.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the House (Amendment #2013-0600h), may have an indeterminable impact on state revenue and expenditures in FY 2014 and each year thereafter. There will be no fiscal impact on county or local revenues and expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill allows individuals insured by a commercial insurance policy, including one issued by a managed care organization, to purchase a 90 day supply of their prescriptions at the retail pharmacy of their choice. The Department indicates retail pharmacies typically dispense a 30 day supply. The Department states, on December 1, 2013, the Medicaid program commenced its managed care program, transitioning over 100,000 Medicaid enrollees to one of three managed care organizations (MCOs). The Department states, in anticipation of the transition to managed care, the New Hampshire Insurance Department issued a bulletin outlining which insurance statutes would apply to the Medicaid Care Management MCOs. The Department indicates the Department of Insurance determined that any provision of RSA 420-J (NH Managed Care Law) that conflicts with Medicaid law would not apply, and applicability of other provisions, for which there is no clear conflict, would be determined on a case-by-case basis. The Department is not aware of any determination of applicability related to RSA 420-J:7-b and therefore, states the fiscal impact to the Medicaid program and the DHHS cannot be determined.
The Department of Insurance states this bill requires insurance carriers to allow those it insures to use retail pharmacies within the insurer’s network when the retail pharmacy is willing to accept the same terms as a mail order pharmacy. The Department assumes the mail order pharmacy negotiated rates would not be affected by the bill. The Department also assumes the bill would not change a carrier’s cost and would have not impact state revenue or expenditures.
The Department of Administrative Services indicates the state employee and retiree health benefit program is self-funded and would not be subject to this insurance law coverage mandate. The Department states this bill would have no fiscal impact on the state employee and retiree health benefit program.
The Department of Corrections states this bill will have no fiscal impact on the Department’s revenue or expenditures.