SB 238-FN - AS AMENDED BY THE SENATE
03/16/2017 0794s
2017 SESSION
17-0855
01/10
SENATE BILL 238-FN
AN ACT relative to the usual and customary price of filling a prescription.
SPONSORS: Sen. Soucy, Dist 18; Sen. Reagan, Dist 17; Rep. McGuire, Merr. 29
COMMITTEE: Health and Human Services
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This bill clarifies the terms "usual and customary price" and "contracted copayment" for the purposes 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/16/2017 0794s 17-0855
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seventeen
AN ACT relative to the usual and customary price of filling a prescription.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Regulation of Pharmacies; Price of Filling Prescriptions. Amend RSA 318:47-h, I to read as follows:
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. For the purposes of this paragraph, "usual and customary price" means the price an individual would pay for a prescription at a retail pharmacy if that individual did not have a prescription drug benefit or insurance. For the purposes of this paragraph, "contracted copayment" means a fixed amount an individual is responsible to pay for covered prescriptions as set forth in the heath benefit plan.
2 Managed Care Law; Price of Filling Prescriptions. Amend RSA 420-J:7-b, X(a) to read as follows:
(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. For the purposes of this subparagraph, "usual and customary price" means the price an individual would pay for a prescription at a retail pharmacy if that individual did not have a prescription drug benefit or insurance. For the purposes of this subparagraph, "contracted copayment" means a fixed amount an individual is responsible to pay for covered prescriptions as set forth in the heath benefit plan.
3 Accident and Health Insurance; Price of Filling Prescriptions. Amend RSA 415:26, I to read as follows:
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. For the purposes of this paragraph, "usual and customary price" means the price an individual would pay for a prescription at a retail pharmacy if that individual did not have a prescription drug benefit or insurance. For the purposes of this paragraph, "contracted copayment" means a fixed amount an individual is responsible to pay for covered prescriptions as set forth in the heath benefit plan.
4 Effective Date. This act shall take effect 60 days after its passage.
17-0855
Revised 2/14/17
SB 238-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to the usual and customary price of filling a prescription.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2018 | FY 2019 | FY 2020 | FY 2021 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
METHODOLOGY:
This bill clarifies the term “usual and customary price” for the purposes of filling prescriptions. The Department of Health and Human Services (DHHS) states current law provides that a pharmacy benefits manager or an 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. The bill adds a definition of usual and customary price to mean the price and individual would pay for a prescription at a retail pharmacy if that individual did not have a prescription drug benefit or insurance. The bill would effectively mean Medicaid recipients who are served under the traditional Medicaid fee for service (FFS) or Medicaid Care Management (MCO) programs would always pay to the pharmacy their Medicaid copay (of $1 for preferred drugs and $2 for non-preferred drugs) as this would qualify as the lesser amount. NH Health Protection Program (NHHPP) participants enrolled in Qualified Health Plans are subject to copays of $4 for preferred drugs and $8 for non-preferred drugs. Even with higher copays, NHHPP participants would be unlikely to pay more than the required copay, and any increased cost would be the responsibility of the participant and not DHHS.
The Insurance Department states the bill requires insurers, pharmacy benefit managers (PBMs) and other entities licensed by the Department to include certain provisions in their contracts with pharmacies. These provisions would require contracted pharmacies to charge the lesser of the contracted copay or the pharmacy’s retail price for every prescription. The Department’s analysis of claims indicates for most pharmacy transactions, the pharmacy charges the amount it has negotiated with the insurer or other entity when that amount is lower than the contracted copay. The Department assumes the negotiated amount is lower than the pharmacy’s retail price. Therefore, the Department assumes this bill will cause an insured’s out-of-pocket expenses to increase, causing insureds to reach their out-of-pocket maximum at an accelerated rate. This may impact claim costs and premiums. The State is self- funded and the Department does not know what, if any, impact this may have on expenditures.
The Office of Professional Licensure and Certification indicates pharmacy budget managers would be required to charge an enrollee or insured person the pharmacy’s “usual and customary price” for prescriptions or the contracted copayment. The Board of Pharmacy does not license or regulate pharmacy managers and has no jurisdiction over prescription drug pricing and insurance providers.
The Department of Administrative Services states the bill is not applicable to the State's self funded Employee Health Benefit Plan and thus there is no fiscal impact on the State.
AGENCIES CONTACTED:
Departments of Health and Human Services, Insurance, Administrative Services, and the Office of Professional Licensure and Certification
| Date | Body | Type |
|---|---|---|
| Feb. 7, 2017 | Senate | Hearing |
| March 16, 2017 | Senate | Floor Vote |
| March 23, 2017 | Senate | Floor Vote |
| April 11, 2017 | House | Hearing |
| April 11, 2017 | House | Exec Session |
| April 20, 2017 | House | Floor Vote |
April 20, 2017: Inexpedient to Legislate: MA VV 04/20/2017 HJ 14 P. 7
April 20, 2017: Committee Report: Inexpedient to Legislate for 04/20/2017 (Vote 13-0; CC) HC 20 P. 6
April 11, 2017: Executive Session: 04/11/2017 LOB 205
April 11, 2017: Public Hearing: 04/11/2017 02:00 PM LOB 205
March 23, 2017: Introduced 03/23/2017 and referred to Health, Human Services and Elderly Affairs HJ 11 P. 26
March 23, 2017: Ought to Pass: MA, VV; OT3rdg; 03/23/2017; SJ 10
March 23, 2017: Committee Report: Ought to Pass, 03/23/2017; SC 15
March 16, 2017: Ought to Pass with Amendment 2017-0794s, MA, VV; Refer to Finance Rule 4-5; 03/16/2017; SJ 9
March 16, 2017: Committee Amendment # 2017-0794s, AA, VV; 03/16/2017; SJ 9
March 16, 2017: Committee Report: Ought to Pass with Amendment # 2017-0794s, 03/16/2017; SC 14
Feb. 7, 2017: Hearing: 02/07/2017, Room 101, LOB, 02:00 pm; SC 9
Jan. 19, 2017: Introduced 01/19/2017 and Referred to Health and Human Services; SJ 5