Revision: March 27, 2014, midnight
SB 422 – AS INTRODUCED
2014 SESSION
01/09
SENATE BILL 422
AN ACT relative to the definition of pharmacy benefit manager.
SPONSORS: Sen. Soucy, Dist 18; Rep. Schlachman, Rock 18; Rep. K. Williams, Hills 4
This bill inserts a definition of pharmacy benefit manager into the statutes.
This bill is a result of the committee to study the regulation of pharmacy benefit managers established under 2013, 182.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
14-2861
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fourteen
AN ACT relative to the definition of pharmacy benefit manager.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Managed Care Law; Definition Added. Amend RSA 420-J:3, XXVIII-a to read as follows:
XXVIII-a. “Pharmacy benefit manager” means any entity that performs pharmacy benefit management for a self-insured employer or insurance carrier. Pharmacy benefit management means the services provided to a self-insured employer or insurance carrier, directly or through another entity, including:
(a) The negotiation of the amount to be paid for prescription medicine or drugs by the self-insured employer or insurance carrier and the amount paid to the independent pharmacy, pharmacy chain, or remote pharmacy dispensing prescription medicine or drugs;
(b) Procurement of prescription medicines or drugs to be dispensed to injured employees; or
(c) The administration or management of prescription medicine or drug benefits, including, but not limited to, any of the following:
(1) Mail services pharmacy;
(2) Claims processing, retail network contracting and management, or payment of claims to pharmacies for dispensing prescription medicines or drugs;
(3) Patient compliance, therapeutic intervention, or generic substitution programs;
(4) Disease management; and
(5) Retrospective review.
XXVIII-aa. “Post-service claim” means any claim for a health benefit to which the terms of the plan do not condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining the medical care or disability benefit. “Post-service claim” shall not include a request for reimbursement made by a provider pursuant to the terms of an agreement between the provider and the health carrier.
2 Pharmacists and Pharmacies; Definition Added. Amend RSA 318:1, XI-a to read as follows:
XI-a. “Pharmacy benefit manager” means any entity that performs pharmacy benefit management for a self-insured employer or insurance carrier. Pharmacy benefit management means the services provided to a self-insured employer or insurance carrier, directly or through another entity, including:
(a) The negotiation of the amount to be paid for prescription medicine or drugs by the self-insured employer or insurance carrier and the amount paid to the independent pharmacy, pharmacy chain, or remote pharmacy dispensing prescription medicine or drugs;
(b) Procurement of prescription medicines or drugs to be dispensed to injured employees; or
(c) The administration or management of prescription medicine or drug benefits, including, but not limited to, any of the following:
(1) Mail services pharmacy;
(2) Claims processing, retail network contracting and management, or payment of claims to pharmacies for dispensing prescription medicines or drugs;
(3) Patient compliance, therapeutic intervention, or generic substitution programs;
(4) Disease management; and
(5) Retrospective review.
XI-aa. “Pharmacy intern” means a person who is registered by the board pursuant to RSA 318:15-b and:
(a) Is enrolled in a professional degree program of a school or college of pharmacy that has been approved by the board and is satisfactorily progressing toward meeting the requirements for licensure as a pharmacist starting no earlier than 4 months prior to the third year of study; or
(b) Is a graduate of an approved professional degree program of a school or college of pharmacy or is a graduate who has established educational equivalency by obtaining a Foreign Pharmacy Graduate Examination Committee (FPGEC) Certificate, who is currently licensed by the board of pharmacy for the purpose of obtaining practical experience as a requirement for licensure as a pharmacist; or
(c) Is a qualified applicant awaiting examination for licensure or meeting board requirements for re-licensure; or
(d) Is participating in a residency or fellowship program.
3 New Paragraph; Rulemaking Added. Amend RSA 318:5-a by inserting after paragraph XVIII the following new paragraph:
XIX. Any other matter relative to the proper administration of this chapter.
4 Effective Date. This act shall take effect 60 days after its passage.