HB1664 (2016) Detail

(New Title) relative to contracts between carriers or pharmacy benefit managers and certain pharmacies.


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CHAPTER 177

HB 1664-FN - FINAL VERSION

9Mar2016... 0846h

11May2016... 1971EBA

2016 SESSION

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HOUSE BILL\t1664-FN

 

AN ACT\trelative to contracts between carriers or pharmacy benefit managers and certain pharmacies.

 

SPONSORS:\tRep. Luneau, Merr. 10; Rep. Myler, Merr. 10; Rep. Butler, Carr. 7; Sen. Feltes, Dist 15

 

COMMITTEE:\tHealth, Human Services and Elderly Affairs

 

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AMENDED ANALYSIS

 

\tThis bill establishes procedures for contracts between carriers or pharmacy benefit managers and contracted pharmacies.

 

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Explanation:\tMatter added to current law appears in bold italics.

\t\tMatter removed from current law appears [in brackets and struckthrough.]

\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.

9Mar2016... 0846h

11May2016... 1971EBA\t16-2664

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STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Sixteen

 

AN ACT\trelative to contracts between carriers or pharmacy benefit managers and certain pharmacies.

 

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

 

\t177:1  New Paragraph; Managed Care; Definitions.  Amend RSA 420-J:3 by inserting after paragraph X the following new paragraph:

\t\tX-a.  “Contracted pharmacy” or “pharmacy” means a pharmacy participating in the network of a pharmacy benefit manager through a direct contract or through a contract with a pharmacy services administration organization or group purchasing organization.

\t177:2  New Paragraph; Managed Care; Definitions.  Amend RSA 420-J:3 by inserting after paragraph XIV the following new paragraph:

\t\tXIV-a.  “Drug product reimbursement” means the amount paid by a carrier or pharmacy benefit manager to a contracted pharmacy or pharmacist for the cost of the drug dispensed to a patient and does not include a dispensing or professional fee.

\t177:3  New Paragraph; Managed Care; Provider Contract Standards.  Amend RSA 420-J:8 by inserting after paragraph XIV the following new paragraph:

\t\tXV.(a)  All contracts between a carrier or pharmacy benefit manager and a contracted pharmacy shall include:

\t\t\t\t(1)  The sources used by the pharmacy benefit manager to calculate the drug product reimbursement paid for covered drugs available under the pharmacy health benefit plan administered by the carrier or pharmacy benefit manager.

\t\t\t\t(2)  A process to appeal, investigate, and resolve disputes regarding the maximum allowable cost pricing.  The process shall include the following provisions:

\t\t\t\t\t(A)  A provision granting the contracted pharmacy or pharmacist at least 30 business days following the initial claim to file an appeal;

\t\t\t\t\t(B)  A provision requiring the carrier or pharmacy benefit manager to investigate and resolve the appeal within 30 business days;

\t\t\t\t\t(C)  A provision requiring that, if the appeal is denied, the carrier or pharmacy benefit manager shall:

\t\t\t\t\t\t(i)  Provide the reason for the denial; and

\t\t\t\t\t\t(ii)  Identify the national drug code of a drug product that may be purchased by contracted pharmacies at a price at or below the maximum allowable cost; and

\t\t\t\t\t(D)  A provision requiring that, if an appeal is granted, the carrier or pharmacy benefits manager shall within 30 business days after granting the appeal:

\t\t\t\t\t\t(i)  Make the change in the maximum allowable cost; and

\t\t\t\t\t\t(ii)  Permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question.

\t\t\t(b)  For every drug for which the pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the pharmacy benefit manager shall:

\t\t\t\t(1)  Include in the contract with the pharmacy information identifying the national drug pricing compendia or sources used to obtain the drug price data.

\t\t\t\t(2)  Make available to a contracted pharmacy the actual maximum allowable cost for each drug.

\t\t\t\t(3)  Review and make necessary adjustments to the maximum allowable cost for every drug for which the price has changed at least every 14 days.

\t177:4  Effective Date.  This act shall take effect January 1, 2017.

Approved: June 3, 2016

Effective Date: January 1, 2017