SB64 (2016) Detail

(Second New Title) relative to payment for filling prescriptions and enforcement concerning prices for filling certain prescriptions.


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SB 64 – AS AMENDED BY THE HOUSE

03/26/2015   0977s

03/26/2015   1107s

6Jan2016...1308h

2015 SESSION

\t15-0589

\t10/01

 

SENATE BILL\t\t64

 

AN ACT\trelative to payment for filling prescriptions and enforcement concerning prices for filling certain prescriptions.

 

SPONSORS:\tSen. Soucy, Dist 18; Sen. Reagan, Dist 17; Rep. Rosenwald, Hills 30

 

COMMITTEE:\tHealth and Human Services

 

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AMENDED ANALYSIS

 

\tThis bill clarifies the process of paying for filling prescriptions for covered persons.  The bill also adds authority for the pharmacy board to adopt rules for enforcement of requirements for the price of filling prescriptions.

 

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\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.

 

03/26/2015   0977s

03/26/2015   1107s

6Jan2016...1308h

\t15-0589

\t10/01

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Fifteen

 

AN ACT\trelative to payment for filling prescriptions and enforcement concerning prices for filling certain prescriptions.

 

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

 

\t1  New Paragraph; Pharmacists and Pharmacies; Filling Prescriptions; Rulemaking Added.  Amend RSA 318:5-a by inserting after paragraph XVIII the following new paragraph:

\t\tXIX.  Establishing procedures to receive complaints of violations of RSA 415:6-aaa and RSA 420-J:7-b, X.  Such rules shall include:

\t\t\t(a)  Criteria and procedures to refer complaints to the insurance department.

\t\t\t(b)  Methods for tracking the status of complaints referred to the insurance department and receiving department of insurance reports on the status.

\t\t\t(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.

\t2  New Section; Filling Prescriptions; Individual.  Amend RSA 415 by inserting after section 6-aa the following new section:

\t415:6-aaa  Filling Prescriptions.

\t\tI.  A pharmacy benefits manager or health carrier shall require that a covered person pay the lesser of the amount charged by the pharmacy for filling the prescription, the provider specified contract payment amount, or the covered person’s benefit copayment.

\t\tII.  Once a pharmacy benefit manager or health carrier has settled a claim for filling a prescription for a covered person and notified the pharmacy of the amount the pharmacy benefits manager or health carrier will pay to the pharmacy for that prescription, the pharmacy benefits manager or health carrier shall not lower the amount to be paid to the pharmacy by the pharmacy benefits manager or the health carrier for such settled claim; provided, however, that this paragraph shall not apply if the claim was submitted fraudulently or with inaccurate or misrepresented information.

\t3  New Paragraph; Managed Care; Filling Prescriptions.  Amend RSA 420-J:7-b by inserting after paragraph IX the following new paragraph:

\t\tX.(a)  Every health benefit plan that provides prescription drug benefits shall require that a covered person pay the lesser of the amount charged by the pharmacy filling the prescription, the provider specified contract payment amount, or the covered person’s benefit copayment.

\t\t\t(b)  Once a pharmacy benefit manager or health carrier has settled a claim for filling a prescription for a covered person and notified the pharmacy of the amount the pharmacy benefits manager or health carrier will pay to the pharmacy for that prescription, the pharmacy benefits manager or health carrier shall not lower the amount to be paid to the pharmacy by the pharmacy benefits manager or the health carrier for such settled claim; provided, however, that this paragraph shall not apply if the claim was submitted fraudulently or with inaccurate or misrepresented information.

\t4  New Paragraph; Managed Care; Provider Contract Standards.  Amend RSA 420-J:8 by inserting after paragraph XIV the following new paragraph:

\t\tXV.(a)  A pharmacy benefits manager or health carrier shall prohibit a pharmacy from collecting more from the covered person than the lesser of the amount charged by the pharmacy for filling the prescription, the specified contract payment amount, or the covered person’s benefit copayment.

\t\t\t(b)  Once a pharmacy benefit manager or health carrier has settled a claim for filling a prescription for a covered person and notified the pharmacy of the amount the pharmacy benefits manager or health carrier will pay to the pharmacy for that prescription, the pharmacy benefits manager or health carrier shall not lower the amount to be paid to the pharmacy by the pharmacy benefits manager or the health carrier for such settled claim; provided, however, that this paragraph shall not apply if the claim was submitted fraudulently or with inaccurate or misrepresented information.

\t5  Repeal.  RSA 318:47-h, relative to the price of filling prescriptions, is repealed.

\t6  Effective Date.  This act shall take effect upon its passage.

 

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\t\t\t\t\t\t\t\t\t\t\t15-0589

\t\t\t\t\t\t\t\t\t\t\tAmended 2/3/16

 

SB 64-FN- FISCAL NOTE

 

AN ACT\t(Second New Title) relative to payment for filling prescriptions and enforcement concerning prices for filling certain prescriptions.

 

 

FISCAL IMPACT:

The Department of Health and Human Services states this bill, as amended by the House (Amendment #2015-1308h), may increase state expenditures by an indeterminable amount in FY 2017 and each year thereafter.  There will be no fiscal impact to state, county, and local revenue or county and local expenditures.  

 

METHODOLOGY:

The Department of Health and Human Services states this bill prevents a pharmacy benefit manager or health carrier from paying a lower amount to a pharmacy for a settled claim unless the claim was submitted fraudulently or with inaccurate information or misrepresented information.  The Department states this bill does not allow for recoupment of a claim if the amount paid should have been less than what was actually paid to the pharmacy.  The Department notes that Managed Care Organizations (MCOs) perform their own post payment review, and if the MCOs are unable to reconcile overpayment, the per member per month rate paid by the Department to the MCOs will increase by an indeterminable amount which could impact state expenditures.  

 

The Department of Insurance assumes this bill will have no impact on claim costs, premiums or premium taxes, or the Department's Administrative fund.

 

The Department of Administrative Services states this bill will likely have no financial impact on the State's health benefit plan.  The State's pharmacy benefit manager, Express Scripts, already requires an individual pay the lesser of the amount charged by the pharmacy, the specified contract payment amount, or the individual's copay.

 

The Office of Professional Licensure states this bill will have no fiscal impact on its operations.