HB1697 (2020) Detail

Relative to prescription drug discount prohibition.


HB 1697-FN - AS INTRODUCED

 

 

2020 SESSION

20-3097

01/05

 

HOUSE BILL 1697-FN

 

AN ACT relative to prescription drug discount prohibition.

 

SPONSORS: Rep. Butler, Carr. 7; Rep. Muscatel, Graf. 12

 

COMMITTEE: Commerce and Consumer Affairs

 

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ANALYSIS

 

This bill prohibits, with limited exceptions, prescription drug manufacturers from offering coupons or discounts to cover insurance copayments or deductibles.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

20-3097

01/05

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty

 

AN ACT relative to prescription drug discount prohibition.

 

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

 

1  New Subdivision; Prescription Drug Discount Prohibition.  Amend RSA 318 by inserting after section 66 the following new subdivision:

Prescription Drug Discount Prohibition

318:67  Prescription Drug Discount Prohibition; Exceptions.  

I.(a)  Except as provided in paragraph III, a pharmacy shall not accept as payment from a patient on behalf of a person who manufactures a prescription drug, a discount, repayment, product voucher, or other reduction in an individual's out-of-pocket expenses associated with his or her health insurance, health care service plan, or other health coverage, including but not limited to, a copayment, coinsurance, or deductible for a prescription drug if a lower cost form of that drug is covered under the individual's health insurance, health care service plan, or other health coverage on a lower cost-sharing tier that is designated to be therapeutically equivalent as indicated by the United States Food and Drug Administration's (FDA) "Approved Drug Products with Therapeutic Equivalence Evaluations."

(b)  The prohibition in subparagraph (a) shall not apply to a branded prescription drug, until the time that the first drug designated in the FDA's "Approved Drug Products with Therapeutic Equivalence Evaluations" as therapeutically equivalent to that branded prescription drug has been nationally available for 6 calendar months.

(c)  A coupon may be accepted as payment if the individual’s out-of-pocket expenses associated with the lower cost form of the drug exceeds $500.

II.  Except as provided in paragraph IV, a pharmacy shall not accept as payment from a patient on behalf of a person who manufactures a prescription drug, a discount, repayment, product voucher, or other reduction in the individual's out-of-pocket expenses associated with his or her health insurance, health care service plan, or other health coverage, including but not limited to a copayment, coinsurance, or deductible, for a prescription drug if the active ingredients of the drug are contained in products regulated by the FDA, are available without prescription at a lower cost, and are not otherwise contraindicated for treatment of the condition for which the prescription drug is approved.

III.  The prohibitions in paragraphs I and II shall not apply to any of the following:

(a)  A discount, repayment, product voucher, or other payment to a patient or another person on the patient's behalf for a prescription drug required under a FDA Risk Evaluation and Mitigation Strategy for the purpose of monitoring or facilitating the use of that prescription drug in a manner consistent with the approved labeling of the prescription drug.

(b)  A single-tablet drug regimen for treatment or prevention of human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) that is as effective as a multitablet regimen, unless, consistent with clinical guidelines and peer-reviewed scientific and medical literature, the multitablet regimen is clinically equally effective or more effective and is more likely to result in adherence to the drug regimen.

(c)  The individual patient has completed any applicable step therapy or prior authorization requirements for the branded prescription drug as mandated by the individual's present or past health insurer, health care service plan, or other health coverage.

(d)  A discount, repayment, product voucher, or other reduction in an individual patient's out-of-pocket expenses for self-pay patients.

IV.(a)  This subdivision shall not prohibit a pharmacy from accepting from a patient on behalf of an entity, including an entity that manufactures prescription drugs or a patient assistance program that is solely funded by one or more manufacturers, a pharmaceutical product free of any cost, if the product is free of cost to both the patient and his or her health insurer, health care service plan, or other health coverage.

(b)(1)  This subdivision shall not prohibit or limit assistance to a patient provided by an independent charity patient assistance program.

(2)  For purposes of this section, "independent charity patient assistance program" means a program that meets all of the following requirements:

(A)  The program does not allow a pharmaceutical manufacturer or an affiliate of the manufacturer, including, but not limited to, an employee, agent, officer, shareholder, contractor, wholesaler, distributor, or pharmacy benefits manager, to exert any direct or indirect influence or control over the charity or subsidy program.

(B)  Assistance is awarded in a truly independent manner that severs any link between a pharmaceutical manufacturer's funding and the beneficiary.

(C)  Assistance is awarded without regard to the pharmaceutical manufacturer's interest and without regard to the beneficiary's choice of product, provider, practitioner, supplier, health insurance, health care service plan, or other health coverage.

(D)  Assistance is awarded based upon a reasonable, verifiable, and uniform measure of financial need that is applied in a consistent manner.

2  New Paragraph; Managed Care Law; Provider Contract Standards.  Amend RSA 420-J:8 by inserting after paragraph XV the following new paragraph:

XVI.(a)(1)  Except as provided in subparagraph (c), no contract between a health carrier or pharmacy benefit manager and a participating pharmacy shall permit the pharmacy to accept as payment anything from a member on behalf of a person who manufactures a prescription drug, a discount, repayment, product voucher, or other reduction in an individual's out-of-pocket expenses associated with his or her health insurance, health care service plan, or other health coverage, including, but not limited to, a copayment, coinsurance, or deductible for a prescription drug if a lower cost form of that drug is covered under the individual's health insurance, health care service plan, or other health coverage on a lower cost-sharing tier that is designated to be therapeutically equivalent as indicated by the United States Food and Drug Administration's (FDA) "Approved Drug Products with Therapeutic Equivalence Evaluations."

(2)  This prohibition shall not apply to a branded prescription drug, until the time that the first drug designated in the FDA's "Approved Drug Products with Therapeutic Equivalence Evaluations" as therapeutically equivalent to that branded prescription drug has been nationally available for 6 calendar months.

(3)  Contracts may allow coupons to be accepted as payment if the individual’s out-of-pocket expenses associated with the lower cost form of the drug exceeds $500.

(b)  Except as provided in subparagraph (d), no contract between a health carrier or a pharmacy benefit manager and a participating pharmacy shall permit the pharmacy to accept as payment, anything from a member on behalf of a person who manufactures a prescription drug a discount, repayment, product voucher, or other reduction in the individual's out-of-pocket expenses associated with his or her health insurance, health care service plan, or other health coverage, including, but not limited to, a copayment, coinsurance, or deductible for a prescription drug if the active ingredients of the drug are contained in products regulated by the FDA, are available without prescription at a lower cost, and are not otherwise contraindicated for treatment of the condition for which the prescription drug is approved.

(c)  The prohibitions in subparagraphs (a) and (b) shall not apply to any of the following:

(1)  A discount, repayment, product voucher, or other payment to a patient or another person on the patient's behalf for a prescription drug required under a FDA Risk Evaluation and Mitigation Strategy for the purpose of monitoring or facilitating the use of that prescription drug in a manner consistent with the approved labeling of the prescription drug.

(2)  A single-tablet drug regimen for treatment or prevention of human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) that is as effective as a multitablet regimen, unless, consistent with clinical guidelines and peer-reviewed scientific and medical literature, the multitablet regimen is clinically equally effective or more effective and is more likely to result in adherence to the drug regimen.

(3)  The individual member has completed any applicable step therapy or prior authorization requirements for the branded prescription drug as mandated by the individual's present or past health insurer, health care service plan, or other health coverage.

(4)  A discount, repayment, product voucher, or other reduction in an individual patient’s out-of-pocket expenses for self-pay patients.

(d)(1)  This paragraph shall not prohibit a pharmacy from accepting from a member on behalf of an entity, including an entity that manufactures prescription drugs or a patient assistance program that is solely funded by one or more manufacturers, a pharmaceutical product free of any cost, if the product is free of cost to both the member and his or her health insurer, health care service plan, or other health coverage.

(2)(A)  This paragraph shall not prohibit or limit assistance to a member provided by an independent charity patient assistance program.

(B)  For purposes of this subparagraph, "independent charity member assistance program" means a program that meets all of the following requirements:

(i)  The program does not allow a pharmaceutical manufacturer or an affiliate of the manufacturer, including, but not limited to, an employee, agent, officer, shareholder, contractor, wholesaler, distributor, or pharmacy benefits manager, to exert any direct or indirect influence or control over the charity or subsidy program.

(ii)  Assistance is awarded in a truly independent manner that severs any link between a pharmaceutical manufacturer's funding and the beneficiary.

(iii)  Assistance is awarded without regard to the pharmaceutical manufacturer's interest and without regard to the beneficiary's choice of product, provider, practitioner, supplier, health insurance, health care service plan, or other health coverage.

(iv)  Assistance is awarded based upon a reasonable, verifiable, and uniform measure of financial need that is applied in a consistent manner.

3  Effective Date.  This act shall take effect January 1, 2021.

 

LBAO

20-3097

Revised 1/9/20

 

HB 1697-FN- FISCAL NOTE

AS INTRODUCED

 

AN ACT relative to prescription drug discount prohibition.

 

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

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

$0

Indeterminable

Indeterminable

Indeterminable

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

Funding Source:

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

 

 

 

 

 

COUNTY:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

 

 

 

 

LOCAL:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

METHODOLOGY:

This bill prohibits with limited exceptions, prescription drug manufacturers from offering coupons or discounts to cover insurance co payments, or deductibles.

 

The Insurance Department states it is uncertain what, if any impact the bill would have on claim costs. Any impact in claim costs would impact health plan pricing and/or design.  Such changes could impact premium tax revenue collected by the State.

 

The Department of Administrative Services indicates the State of New Hampshire Employee and Retiree Health Benefit Plan (Plan) is a self-funded, government plan and managed care law would not apply.  The Plan's Pharmacy Benefit Manager's (PBM) network pharmacies are required to comply with pharmacy laws.  The Department is not able to quantify the frequency of coupon utilization at retail pharmacies, but indicates coupons are not accepted through the Plan's home delivery mail order pharmacy.  The Department assumes, if drug manufacturers are no longer able to use coupons or discount cards to negate utilization management programs and formulary management  efforts included in the State's PBM contract, the Plan is likely to benefit financially.  Any potential fiscal impact is indeterminable.

 

The Department of Health and Human Services indicates this bill is not likely to have a fiscal impact on the Medicaid program.  Drug manufacturers' prescription drug discounts, repayment and product vouchers are not applicable to government programs such as Medicaid and Medicare.

 

AGENCIES CONTACTED:

Departments of Insurance, Administrative Services and Health and Human Services

 

Links

HB1697 at GenCourtMobile
HB1697 Discussion

Action Dates

Date Body Type
Feb. 5, 2020 House Hearing
March 3, 2020 House Exec Session

Bill Text Revisions

HB1697 Revision: 7810 Date: Jan. 13, 2020, 3:45 p.m.

Docket

Date Status
Jan. 8, 2020 Introduced 01/08/2020 and referred to Commerce and Consumer Affairs HJ 1 P. 32
Feb. 5, 2020 Public Hearing: 02/05/2020 01:45 pm LOB 302
Feb. 18, 2020 Subcommittee Work Session: 02/18/2020 09:30 am LOB 302
March 3, 2020 Executive Session: 03/03/2020 10:30 am LOB 302
Committee Report: Refer for Interim Study (Vote 18-1; CC)
March 11, 2020 Committee Report: Refer for Interim Study for 03/11/2020 (Vote 18-1; CC) HC 10 P. 8
March 11, 2020 Removed from Consent (Rep. Sylvia) 03/11/2020
March 12, 2020 Refer for Interim Study: MA VV 03/12/2020