Text to be removed highlighted in red.
1 Managed Care; Provider Contract Standards. Amend the introductory paragraph of RSA 420-J:8, XV(b) to read as follows:
(b) For every drug for which the health carrier or pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the health carrier or pharmacy benefit manager shall:
2 New Subparagraph; Managed Care; Provider Contract Standards. Amend RSA 420-J:8, XV by inserting after subparagraph (d) the following new subparagraph:
(e) A carrier or pharmacy benefit manager shall include in its contract with the pharmacy terms limiting increases in the maximum allowable cost or other allowable payment maximums for drugs with a maximum allowable cost above $25 to 100 percent of the beginning maximum allowable cost on the first day of any 90-day period to the last day of the 90-day period, without approval of the department of insurance. The carrier shall submit requests for approval to the department of insurance by including the national drug code and the increase requested. The department shall report publicly the prescription drug name and increase in the annual report required under RSA 420-G:14-a, VI(a).
3 Effective Date. This act shall take effect 60 days after its passage.
Text to be added highlighted in green.
1 Managed Care; Provider Contract Standards. Amend the introductory paragraph of RSA 420-J:8, XV(b) to read as follows:
(b) For every drug for which the health carrier or pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the health carrier or pharmacy benefit manager shall:
2 New Subparagraph; Managed Care; Provider Contract Standards. Amend RSA 420-J:8, XV by inserting after subparagraph (d) the following new subparagraph:
(e) A carrier or pharmacy benefit manager shall include in its contract with the pharmacy terms limiting increases in the maximum allowable cost or other allowable payment maximums for drugs with a maximum allowable cost above $25 to 100 percent of the beginning maximum allowable cost on the first day of any 90-day period to the last day of the 90-day period, without approval of the department of insurance. The carrier shall submit requests for approval to the department of insurance by including the national drug code and the increase requested. The department shall report publicly the prescription drug name and increase in the annual report required under RSA 420-G:14-a, VI(a).
3 Effective Date. This act shall take effect 60 days after its passage.