SB 64 – AS AMENDED BY THE SENATE
03/26/2015 0977s
03/26/2015 1107s
2015 SESSION
10/01
SENATE BILL 64
AN ACT relative to rulemaking authority and enforcement concerning prices for filling certain prescriptions.
SPONSORS: Sen. Soucy, Dist 18; Sen. Reagan, Dist 17; Rep. Rosenwald, Hills 30
COMMITTEE: Health and Human Services
AMENDED ANALYSIS
This bill adds rulemaking authority for the pharmacy board concerning the price of filling prescriptions paid by a pharmacy benefits manager or insurer. The bill also adds authority for the insurance department to adopt rules for enforcement of requirements for the price of filling prescriptions.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/26/2015 0977s
03/26/2015 1107s
15-0589
10/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fifteen
AN ACT relative to rulemaking authority and enforcement concerning prices for filling certain prescriptions.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Pharmacists and Pharmacies; Price of Filling Prescriptions. Amend RSA?318:47-h by inserting after paragraph II the following new paragraph:
III. The board shall adopt rules under RSA 541-A establishing procedures to receive complaints of violations of paragraphs I and II. Such rules shall include:
(a) Criteria and procedure to refer complaints to the insurance department.
(b) Method for tracking the status of complaints referred to the insurance department and receiving department of insurance reports on the status.
(c) Procedures for reporting to the senate president, the speaker of the house of representatives, and the chairpersons of the house and senate committees with oversight of pharmacy benefit manager regulation the number of complaints received, the number and nature of complaints referred to the insurance department, and the status of referred complaints.
2 New Paragraph; Managed Care Law; Prescriptions; Price of Filling Prescriptions. Amend RSA 420-J:7-b by inserting after paragraph IX the following new paragraph:
X.(a) A pharmacy benefits manager or insurer shall require a contracted pharmacy to charge an enrollee or insured person the pharmacy’s usual and customary price of filling the prescription or the contracted copayment, whichever is less.
(b) Once it has settled a claim for filling a prescription for an enrollee or insured person and notified the pharmacy of the amount the pharmacy benefits manager or insurer will pay to the pharmacy for that prescription, the pharmacy benefits manager or insurer shall not lower the amount to be paid to the pharmacy by the pharmacy benefits manager or the insurer for such settled claim; provided, however, that this paragraph shall not apply if the claim was submitted fraudulently or with inaccurate or misrepresented information.
(c) The commissioner shall adopt rules under RSA 541-A to implement this paragraph. Such rules shall include procedures for addressing complaints, provisions for enforcement, the receipt of complaints referred to the insurance department under RSA 318:47-h, III(b), and for reporting to the board of pharmacy on the status of complaints referred.
3 New Section; Accident and Health Insurance; Price of Filling Prescriptions. Amend RSA?415 by inserting after section 25 the following new section:
415:26 Price of Filling Prescriptions.
I. A pharmacy benefits manager or insurer shall require a contracted pharmacy to charge an enrollee or insured person the pharmacy’s usual and customary price of filling the prescription or the contracted copayment, whichever is less.
II. Once it has settled a claim for filling a prescription for an enrollee or insured person and notified the pharmacy of the amount the pharmacy benefits manager or insurer will pay to the pharmacy for that prescription, the pharmacy benefits manager or insurer shall not lower the amount to be paid to the pharmacy by the pharmacy benefits manager or the insurer for such settled claim; provided, however, that this paragraph shall not apply if the claim was submitted fraudulently or with inaccurate or misrepresented information.
III. The commissioner shall adopt rules under RSA 541-A to implement this paragraph. Such rules shall include procedures for addressing complaints, provisions for enforcement, the receipt of complaints referred to the insurance department under RSA 318:47-h, III(b), and for reporting to the board of pharmacy on the status of complaints referred.
4 Insurance Department; Rulemaking. The commissioner of insurance shall adopt rules under 541-A within 180 days of the effective date of this act to implement the authority established in RSA?420-J:7-b, X and RSA 415:26 by this act.
5 Effective Date. This act shall take effect upon its passage.