Bill Text - SB332 (2018)

Relative to medication synchronization.


Revision: March 12, 2018, 9:33 a.m.

SB 332 - AS AMENDED BY THE SENATE

 

02/15/2018   0418s

2018 SESSION

18-2723

01/04

 

SENATE BILL 332

 

AN ACT relative to medication synchronization.

 

SPONSORS: Sen. Gray, Dist 6; Sen. Carson, Dist 14; Sen. Soucy, Dist 18; Sen. Fuller Clark, Dist 21; Sen. Hennessey, Dist 5; Rep. Kotowski, Merr. 24; Rep. LeBrun, Hills. 32; Rep. J. Edwards, Rock. 4; Rep. M. MacKay, Hills. 30; Rep. Bove, Rock. 5

 

COMMITTEE: Health and Human Services

 

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AMENDED ANALYSIS

 

This bill requires insurers offering health insurance policies with prescription drug coverage to allow covered persons to synchronize the dispensing dates of their prescription drugs.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

02/15/2018   0418s 18-2723

01/04

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Eighteen

 

AN ACT relative to medication synchronization.

 

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

 

1  New Section; Medication Synchronization.  Amend RSA 415 by inserting after section 26 the following new section:

415:27  Medication Synchronization.

I.  An individual or group health insurance plan or policy providing prescription drug coverage in New Hampshire, shall permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a 30-day supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a 30-day supply for the purpose of synchronizing the patient's medications.  For the purposes of this paragraph, the insured's or enrollee's maintenance prescription drugs to be synchronized shall meet all of the following requirements:

(a)  They are covered by the policy, certificate, or contract described in this chapter.

(b)  They are used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee.

(c)  Except as otherwise provided in this paragraph, they are not a controlled substance included in schedules II-V.

(d)  They meet all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple, maintenance-prescription drugs.

(e)  They are of a formulation that can be effectively split over required short-fill periods to achieve synchronization.

(f)  They do not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.

II.  The plan or policy described in paragraph I shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.

III.  The plan or policy described in paragraph I shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.

IV.  A synchronization shall only occur once per year per maintenance-prescription drug.

2  New Section; Medication Synchronization; Managed Care Plan.  Amend RSA 420-J by inserting after section 18 the following new section:

420-J:19  Medication Synchronization.

I.  An individual or group health insurance plan or policy providing prescription drug coverage in New Hampshire, shall permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a 30-day supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a 30-day supply for the purpose of synchronizing the patient's medications.  For the purposes of this paragraph, the insured's or enrollee's maintenance prescription drugs to be synchronized shall meet all of the following requirements:

(a)  They are covered by the policy, certificate, or contract described in this chapter.

(b)  They are used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee.

(c)  Except as otherwise provided in this paragraph, they are not a controlled substance included in schedules II-V.

(d)  They meet all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple, maintenance-prescription drugs.

(e)  They are of a formulation that can be effectively split over required short-fill periods to achieve synchronization.

(f)  They do not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.

II.  The plan or policy described in paragraph I shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.

III.  The plan or policy described in paragraph I shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.

IV.  A synchronization shall only occur once per year per maintenance-prescription drug.

3  Effective Date.  This act shall take effect January 1, 2019.

 

LBAO

18-2723

Amended 3/7/18

 

SB 332- FISCAL NOTE

AS AMENDED BY THE SENATE  (AMENDMENT #2018-0418s)

 

AN ACT relative to medication synchronization.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [ X ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2019

FY 2020

FY 2021

FY 2022

   Appropriation

$0

$0

$0

$0

   Revenue

Indeterminable

Indeterminable

Indeterminable

Indeterminable

   Expenditures

Indeterminable

Indeterminable

Indeterminable

Indeterminable

Funding Source:

  [ X ] General            [    ] Education            [ X ] Highway           [ X ] Other - Various Governmental Funds

 

 

 

 

 

LOCAL:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

Indeterminable

Indeterminable

Indeterminable

Indeterminable

 

METHODOLOGY:

The Department of Administrative Services interprets this bill to require individual group health insurance plans or policies to allow a patient to synchronize medication fills and/or refills for all covered prescriptions that treat a patient's chronic, long-term care condition.  The bill would also require plans or policies to apply a prorated, daily cost-sharing rate for covered prescriptions dispensed by an in-network pharmacy for less than a 30-day supply if:

  • The prescriber or pharmacist determines that the abbreviated supply is in the best interests of the patient for management or treatment of the condition;
  • The patient requests or agrees to receive less than a 30-day supply for  the purpose of synchronizing the patient's medications; and
  • The maintenance prescription drugs to be synchronized meet explicit conditions with regard to: coverage, use, available refills, utilization management requirements; formulation; quantity limits and, except as otherwise provided, the drugs are not II-V scheduled substances.

 

The bill provides that insurers shall pay dispensing fees, but not prorated dispensing fees.  It also provides that synchronization shall occur "once per year per maintenance-prescription drug."  Thus, each time a maintenance prescription drug is prescribed, a patient can request that it be synchronized.  The State Retiree Health Benefit Plan (HBP) is not subject to RSA Chapters 415 or 420-J, and therefore the bill will not directly impact the HBP.  However, the HBP's third party administrator for prescription medication (TPA-Rx) is subject to those chapters for fully insured clients, and is likely to apply the required changes across its New Hampshire book of business.  The fiscal impact to the State is indeterminable because the HBP may be impacted by changes made by this bill that impact the HBP's TPA-Rx.  If the HBP's TPA-Rx is required to adopt the medication synchronization process outlined here, the HBP will be impacted by an indeterminable increase in dispensing fees and indeterminable costs for administrative tracking.  Presumably, the required administrative tracking to document that a pharmacist or prescriber concludes an abbreviated supply is in the best interests of the patient, and that the patient agrees to the abbreviated supply, will be done by the TPA-Rx.  The Department expects costs associated with administrative tracking will be passed on to the HBP in its forthcoming TPA-Rx contract, effective 1/1/19.

 

The Insurance Department assumes that carriers and Pharmacy Benefit Managers (PBMs) typically do not prorate cost sharing when efforts are made to synchronize medication fills or refills.  Synchronizing the medication refills would result in the patient experiencing a copay or other cost sharing amount earlier or later, when a drug refill date is moved up, or back, to do the synchronization.  Making changes to the current practice may have an indeterminable impact on claims costs, due to the proration of cost sharing and potential patient behavior changes.  The Department believes there will be additional administrative costs to the carrier/PBM associated with making changes to the calculation of cost sharing amounts on a prorated basis, and those costs may pass through and impact premiums by an indeterminable amount and therefore impact the premium tax by an indeterminable amount.      

 

The Department of Health and Human Services administers the state Medicaid program and the New Hampshire Health Protection Program, Premium Assistance Program.  The Department makes the following assumptions:

  1. The provisions of this bill would apply to contracts between the Department and managed care companies and pharmacy benefit managers that are effective on or after January 1, 2019.
  2. The bill as amended could have an indeterminable fiscal impact on the state Medicaid program as follows:

1. The Department utilizes a Pharmacy Benefit Manager (PBM) for its Medicaid fee for service program.  The Medicaid PBM processes pharmacy claims through a Point of Sale (POS) claims processing system.  The current POS system is not programed to process the submission clarification codes required to identify a claim as a medication synchronization claim.  The Medicaid PBM would require programing changes to their POS system to accept the new submission clarification codes and to be able to prorate the daily cost sharing rate.  The cost of required programing changes is unknown at this time.

2. Each Medicaid Managed Care Organization (MCO) that contracts with DHHS utilizes a PBM to manage its pharmacy program.  The Medicaid MCO PBMs would also require programing changes to their POS systems in order to accept the new submission clarification codes and to be able to prorate the daily cost sharing rate.  The cost of required programming changes is unknown at this time.

3. Programing changes would also be required for the State’s Medicaid Management Information System (MMIS) to accept these new values.  The claim layouts for the interfaces between the MMIS and the Medicaid PBM and the MCOs would need to be modified for the paid claim information to be accepted into the MMIS.  The cost of required programming changes is unknown at this time.

4. Medicaid beneficiaries are responsible for copayments for most prescription medications.  These copays vary from zero (for certain specific medications /classes of beneficiaries) to $1 for preferred medications and $2 for non-preferred medications.  It is noted that governing regulations provide that if a non-preferred medication is authorized, the medication is deemed a preferred medication for co-payment purposes.  

5. In order for the proposed legislation to have a fiscal impact on Medicaid spending; the prescriber, the pharmacist and the patient would all have to agree to less than a 30 day supply for medication synchronization purposes.  The bill requires the copay be prorated to a daily cost share.

6. The bill requires the full dispensing fee to be paid rather than a prorated daily dispense fee.  The Medicaid FFS dispense fee is $10.47 per prescription.  The average Medicaid MCO dispense fee is approximately $1.50 per prescription.

 

The Department indicates the potential cost cannot be determined because it is not possible to estimate how often Medicaid beneficiaries will choose to work with their prescribers and pharmacists to receive less than a 30 day supply for medication synchronization purposes.

 

The New Hampshire Municipal Association indicates  it is possible that this change will affect the cost of health insurance in New Hampshire, including insurance costs paid by municipalities.  However, the Association has no way of determining whether there will be such an effect, or the amount of any impact.

 

AGENCIES CONTACTED:

Departments of Administrative Services, Insurance and Health and Human Services and New Hampshire Municipal Association