1 Findings. The general court finds that the referral of a patient to a pharmacy with a mutually beneficial financial relationship not limited to but including investment in or ownership with a health carrier or pharmacy benefit manager for pharmacy care represents a potential conflict of interest. These referral practices may limit or eliminate competitive alternatives in the health care services market, may result in overutilization of health care services, may increase costs to the health care system, may adversely affect the quality of health care, may disproportionately harm patients in rural and medically underserved areas, and are against the public policy of this state.

2 New Subdivision; Pharmacy Anti-Steering and Transparency. Amend RSA 318 by inserting after section 66 the following new subdivision:

Pharmacy Anti-Steering and Transparency

318:67 Definitions. In this subdivision:

I. "Affiliate" means a person or entity licensed as a health carrier as defined in RSA 420-J:3, XXIII or registered as pharmacy benefit manager as defined in RSA 402-N:1, VIII, which, either directly or indirectly through one or more intermediaries:

(a) Has a significant financial relationship with or an investment or ownership interest in a pharmacy licensed in this state;

(b) Shares common ownership with a pharmacy licensed in this state; or

(c) Has as an investor or ownership interest holder a pharmacy licensed in this state.

II.(a) "Referral" means:

(1) Ordering of a patient to a pharmacy by an affiliate either orally or in writing, including online messaging;

(2) Offering or implementing plan designs that require or incentivize patients to utilize affiliated pharmacies; or

(3) Patient or prospective patient specific advertising, marketing, or promotion of a pharmacy by an affiliate.

(b) The term "referral" shall not include a pharmacy's inclusion by an affiliate in communications to patients, including patient and prospective patient specific communications, regarding network pharmacies and prices, provided that the affiliate includes information regarding eligible nonaffiliate pharmacies in such communications and the information provided is accurate.

318:68 Pharmacy Anti-Steering and Transparency.

I. A pharmacy shall be prohibited from presenting a claim for payment to any individual, third-party payor, affiliate, or other entity for a service furnished pursuant to a referral from an affiliate; provided, however, that this shall not apply to referrals from an affiliate for limited distribution prescription drugs or specialty prescription drugs, unless the pharmacy is a Utilization Review Accreditation Commission (URAC), Accreditation Commission for Health Care (ACHC), or the Center for Pharmacy Practice Accreditation (CPPA) accredited specialty pharmacy, in which case such prohibition shall apply.

II. This section shall not be construed to prohibit a pharmacy from entering into an agreement with an affiliate to provide pharmacy care to patients, provided that the pharmacy does not receive referrals in violation of paragraph I and the pharmacy provides the disclosures required in paragraph III.

III. If a pharmacy has an affiliate, it shall annually file with the board a disclosure statement identifying all such affiliates.

IV. In addition to any other remedy provided by law, a violation of this section by a pharmacy shall be grounds for disciplinary action by the board.

V. This section shall not apply to any hospital or related entity, or to any referrals by an affiliate for pharmacy services and prescriptions to patients in skilled nursing facilities, intermediate care facilities, continuing care facilities, home health agencies, or hospices, or to requirements for pharmacy benefits in affiliate's health plans for its own employees.

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

1 Findings. The general court finds that the referral of a patient to a pharmacy with a mutually beneficial financial relationship not limited to but including investment in or ownership with a health carrier or pharmacy benefit manager for pharmacy care represents a potential conflict of interest. These referral practices may limit or eliminate competitive alternatives in the health care services market, may result in overutilization of health care services, may increase costs to the health care system, may adversely affect the quality of health care, may disproportionately harm patients in rural and medically underserved areas, and are against the public policy of this state.

2 New Subdivision; Pharmacy Anti-Steering and Transparency. Amend RSA 318 by inserting after section 66 the following new subdivision:

Pharmacy Anti-Steering and Transparency

318:67 Definitions. In this subdivision:

I. "Affiliate" means a person or entity licensed as a health carrier as defined in RSA 420-J:3, XXIII or registered as pharmacy benefit manager as defined in RSA 402-N:1, VIII, which, either directly or indirectly through one or more intermediaries:

(a) Has a significant financial relationship with or an investment or ownership interest in a pharmacy licensed in this state;

(b) Shares common ownership with a pharmacy licensed in this state; or

(c) Has as an investor or ownership interest holder a pharmacy licensed in this state.

II.(a) "Referral" means:

(1) Ordering of a patient to a pharmacy by an affiliate either orally or in writing, including online messaging;

(2) Offering or implementing plan designs that require or incentivize patients to utilize affiliated pharmacies; or

(3) Patient or prospective patient specific advertising, marketing, or promotion of a pharmacy by an affiliate.

(b) The term "referral" shall not include a pharmacy's inclusion by an affiliate in communications to patients, including patient and prospective patient specific communications, regarding network pharmacies and prices, provided that the affiliate includes information regarding eligible nonaffiliate pharmacies in such communications and the information provided is accurate.

318:68 Pharmacy Anti-Steering and Transparency.

I. A pharmacy shall be prohibited from presenting a claim for payment to any individual, third-party payor, affiliate, or other entity for a service furnished pursuant to a referral from an affiliate; provided, however, that this shall not apply to referrals from an affiliate for limited distribution prescription drugs or specialty prescription drugs, unless the pharmacy is a Utilization Review Accreditation Commission (URAC), Accreditation Commission for Health Care (ACHC), or the Center for Pharmacy Practice Accreditation (CPPA) accredited specialty pharmacy, in which case such prohibition shall apply.

II. This section shall not be construed to prohibit a pharmacy from entering into an agreement with an affiliate to provide pharmacy care to patients, provided that the pharmacy does not receive referrals in violation of paragraph I and the pharmacy provides the disclosures required in paragraph III.

III. If a pharmacy has an affiliate, it shall annually file with the board a disclosure statement identifying all such affiliates.

IV. In addition to any other remedy provided by law, a violation of this section by a pharmacy shall be grounds for disciplinary action by the board.

V. This section shall not apply to any hospital or related entity, or to any referrals by an affiliate for pharmacy services and prescriptions to patients in skilled nursing facilities, intermediate care facilities, continuing care facilities, home health agencies, or hospices, or to requirements for pharmacy benefits in affiliate's health plans for its own employees.

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