Revision: Jan. 16, 2019, 9:36 a.m.
HB 657 - AS INTRODUCED
2019 SESSION
19-0801
01/03
HOUSE BILL 657
AN ACT relative to the lowest cost option in the formulary under the managed care law.
SPONSORS: Rep. Butler, Carr. 7; Rep. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. Hennessey, Graf. 1; Sen. Sherman, Dist 24
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill requires health plans offering prescription drug benefits under the managed care law to include on the formulary the drug with the lowest cost option for the insured.
This bill is a result of the commission to study greater transparency in pharmaceutical costs and rebate programs established in 2018, 350.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0801
01/03
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
AN ACT relative to the lowest cost option in the formulary under the managed care law.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Managed Care; Prescription Drugs. Amend RSA 420-J:7-b, III to read as follows:
III.(a) Every health plan that provides prescription drug benefits shall notify covered persons affected by deletions to the plan list or plan formulary, provide an explanation of the exception process by which a covered person can access nonformulary medically necessary prescription drugs, and provide a toll-free telephone number through which a covered person can request additional information. For purposes of this paragraph, covered persons affected by deletions to the plan list or plan formulary shall include those covered persons for whom the health plan has provided coverage for the deleted prescription drugs during the 12-month period immediately prior to the deletion. Upon notification to covered persons, the health benefit plan shall allow at least 45 days before implementation of any formulary deletions; provided, however, that advance notice shall not be required if the federal Food and Drug Administration has determined that a prescription drug on the health benefit plan's formulary is unsafe.
(b) Every health plan that provides prescription drug benefits shall include on the formulary the drug with the lowest cost option for the member, among drugs approved by the federal Food and Drug Administration for treating a specific condition. The lowest cost option shall include package sizing, administration, and dispensing methods. If a carrier uses a third party to administer a prescription drug benefit, such as a pharmacy benefit manager or similar entity, this formulary requirement shall also apply to drugs with a lower maximum allowable cost when there is no cost difference for the member.
2 Effective Date. This act shall take effect 60 days after its passage.