Revision: Dec. 12, 2017, 12:58 p.m.
SB 354 - AS INTRODUCED
2018 SESSION
18-2994
01/05
SENATE BILL 354
AN ACT relative to pharmacy claim fees and copayments.
SPONSORS: Sen. Soucy, Dist 18; Sen. Reagan, Dist 17; Rep. Hennessey, Graf. 1; Rep. Luneau, Merr. 10; Rep. Myler, Merr. 10
COMMITTEE: Commerce
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ANALYSIS
This bill prohibits a pharmacy benefits manager or insurer from charging or holding a pharmacy responsible for a fee related to a claim under certain circumstances. This bill also prohibits a pharmacy benefits manager or insurer from charging higher copayments and or inserting gag clauses in contracts.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
18-2994
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eighteen
AN ACT relative to pharmacy claim fees and copayments.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Pharmacy Claim Fees, Copayments. Amend RSA 318 by inserting after section 47-k the following new section:
318:47-l Pharmacy Claim Fees; Copayments.
I. In this section:
(a) "Adjudication process" means the procedure of paying or denying a claim submitted by a participating pharmacy to a pharmacy benefits manager or insurer.
(b) "Claim" means a vehicle, electronic or otherwise, by which a participating pharmacy submits prescription data for a covered person's prescription order.
(c) "Gag clause" means language present in contracts between pharmacies and pharmacy benefits managers or insurers which prevents divulgence to a covered person monetary matters that would prove beneficial in lowering costs to that covered person, with respect to a processed prescription order.
II. A pharmacy benefits manager or insurer shall not directly or indirectly charge or hold a pharmacy responsible for a fee related to a claim:
(a) That is not apparent at the time of claim processing;
(b) That is not reported on the remittance advice of an adjudicated claim; or
(c) After the initial claim is adjudicated at the point of sale.
III. A pharmacy benefits manager or insurer shall not charge a patient a copayment which exceeds the cost of the medication. If a patient pays a copayment, the dispensing provider or pharmacy shall not redact the adjudicated cost.
IV. A pharmacy or pharmacist may provide relevant information to a patient if the patient is acquiring prescription drugs. This information may include the cost and clinical efficacy of a more affordable alternative drug if one is available. Gag orders of such a nature placed on a pharmacy or pharmacy shall be prohibited.
2 New Section; Pharmacy Claim Fees; Copayments. Amend RSA 420-J by inserting after section 8-d the following new section:
420-J:8-e Pharmacy Claim Fees; Copayments.
I. In this section:
(a) "Adjudication process" means the procedure of paying or denying a claim submitted by a participating pharmacy to a pharmacy benefits manager or insurer.
(b) "Claim" means a vehicle, electronic or otherwise, by which a participating pharmacy submits prescription data for a covered person's prescription order.
(c) "Gag clause" means language present in contracts between pharmacies and pharmacy benefits managers or insurers which prevents divulgence to a covered person monetary matters that would prove beneficial in lowering costs to that covered person, with respect to a processed prescription order.
II. A pharmacy benefits manager or insurer shall not directly or indirectly charge or hold a pharmacy responsible for a fee related to a claim:
(a) That is not apparent at the time of claim processing;
(b) That is not reported on the remittance advice of an adjudicated claim; or
(c) After the initial claim is adjudicated at the point of sale.
III. A pharmacy benefits manager or insurer shall not charge a patient a copayment which exceeds the cost of the medication. If a patient pays a copayment, the dispensing provider or pharmacy shall not redact the adjudicated cost.
IV. A pharmacy or pharmacist may provide relevant information to a patient if the patient is acquiring prescription drugs. This information may include the cost and clinical efficacy of a more affordable alternative drug if one is available. Gag orders of such a nature placed on a pharmacy or pharmacy shall be prohibited.
3 Effective Date. This act shall take effect 60 days after its passage.