Bill Text - SB97 (2021)

(New Title) relative to in-network retail pharmacies.


Revision: Feb. 18, 2021, 6:05 p.m.

SB 97 - AS AMENDED BY THE SENATE

 

02/18/2021   0326s

2021 SESSION

21-0407

08/06

 

SENATE BILL 97

 

AN ACT adopting omnibus legislation relative to health insurance.

 

SPONSORS: Sen. Hennessey, Dist 1

 

COMMITTEE: Health and Human Services

 

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ANALYSIS

 

This bill adopts legislation:

 

I.  Relative to direct primary care referral parity.

 

II.  Relative to in-network retail pharmacies.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

02/18/2021   0326s 21-0407

08/06

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty One

 

AN ACT adopting omnibus legislation relative to health insurance.

 

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

 

1  Sponsorship. This act consists of the following proposed legislation:

Part I. LSR 21-0407, relative to direct primary care referral parity, sponsored by Sen. Hennessey, Prime/Dist 1; Sen. Sherman, Dist 24; Rep. Umberger, Carr 2; Rep. Marsh, Carr 8; and Rep. Woods, Merr 23.

Part II. LSR 21-1017, relative to in-network retail pharmacies, sponsored by Sen. Hennessey, Prime/Dist 1; Sen. Rosenwald, Dist 13; Sen. Soucy, Dist 18; and Rep. Merchant, Sull 4.

2  Legislation Enacted.  The general court hereby enacts the following legislation:

PART I

Relative to direct primary care referral parity.

1  New Section; Primary Care Referral Parity.  Amend RSA 420-J by inserting after section 6-e the following new section:

420-J:6-f Referrals and Orders from Certified Direct Primary Care Providers. The department shall review direct primary care agreements submitted by direct primary care providers and shall certify the first 10 which it determines to be fully compliant with the provisions of RSA 329:1-e.  A health benefit plan under this chapter shall not deny or reduce payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a certified direct primary care provider who is not a member of the carrier’s provider network, provided it would have covered the same services if ordered by an in-network provider, subject to the following limitations:

I. No payment shall be made to the certified direct primary care provider for primary care services covered by the direct primary care agreement pursuant to RSA 329:1-e, II(f).

II. An insurer shall not apply a deductible, coinsurance, or copayment greater than the applicable deductible, coinsurance, or copayment that would apply to the same health care service if the service was referred or ordered by an in-network participating primary care provider.

III. An insurer may require the direct primary care provider to file a written attestation or a copy of the certified direct primary care agreement to demonstrate that the provider is a direct primary care provider.

IV. Health care services may be subject to utilization review by the insurer.

V. The covered person shall retain the right to choose direct primary care on an elective, self-pay basis; no entity regulated under this chapter shall prohibit a certified direct primary care provider from continuing care on an elective, self-pay basis.

VI. Direct primary care providers shall not be required to contract as participating providers in any network.

VII.  On or before October 1, 2025, the insurance department shall report to the joint legislative oversight committee on health and human services, established in RSA 126-A:13, relative to any change in expenses to insurers and any resultant changes in insurance rates attributable to this section, as well as any other impacts of direct primary care on the insurance market or health care coverage.

2  Repeal.  RSA 420-J:6-f, relative to referrals and orders from certified direct primary care providers, is repealed.

3  Effective Date.  

I. Section 2 of this act shall take effect January 1, 2027.

II. The remainder of this act shall take effect January 1, 2022.

PART II

Relative to in-network retail pharmacies.

1  New Section; Pharmacy Benefits Managers; Prohibited Acts.  Amend RSA 402-N by inserting after section 4 the following new section:

402-N:4-a  Prohibited Acts.  A pharmacy benefit manager shall not, either directly or indirectly:

I.  Prohibit an in-network retail pharmacy from:

(a)  Mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network retail pharmacy provided that confirmation of delivery is obtained.

(b)  Charging a shipping or handling surcharge to an enrollee who requests that the in-network retail pharmacy mail or deliver a prescription drug to the enrollee as an ancillary service provided the enrollee receives a disclosure from the in-network retail pharmacy regarding any surcharge to be charged to the patient for the delivery of a prescription drug, including that the surcharge may not be reimbursable by the plan sponsor or pharmacy benefit manager.

(c)  Offering the ancillary services described in subparagraph I(a) to an enrollee.

II.  Charge an enrollee who uses an in-network retail pharmacy that offers to mail or deliver a prescription drug to an enrollee as an ancillary service a surcharge for the delivery of a prescription drug or copayment that is higher than the surcharge or copayment the enrollee would pay if the enrollee used an in-network retail pharmacy that does not offer to mail or deliver a prescription drug to an enrollee as an ancillary service.

III. For purposes of this section, a retail pharmacy shall not include a “mail-order pharmacy” as defined in RSA 318:1, VII-b.

2  Effective Date.  Part II of this act shall take effect 60 days after its passage.

SB 97 - AS AMENDED BY THE SENATE

 

02/18/2021   0326s

2021 SESSION

21-0407

08/06

 

SENATE BILL 97

 

AN ACT adopting omnibus legislation relative to health insurance.

 

SPONSORS: Sen. Hennessey, Dist 1

 

COMMITTEE: Health and Human Services

 

-----------------------------------------------------------------

 

ANALYSIS

 

This bill adopts legislation:

 

I.  Relative to direct primary care referral parity.

 

II.  Relative to in-network retail pharmacies.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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.

02/18/2021   0326s 21-0407

08/06

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty One

 

AN ACT adopting omnibus legislation relative to health insurance.

 

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

 

1  Sponsorship. This act consists of the following proposed legislation:

Part I. LSR 21-0407, relative to direct primary care referral parity, sponsored by Sen. Hennessey, Prime/Dist 1; Sen. Sherman, Dist 24; Rep. Umberger, Carr 2; Rep. Marsh, Carr 8; and Rep. Woods, Merr 23.

Part II. LSR 21-1017, relative to in-network retail pharmacies, sponsored by Sen. Hennessey, Prime/Dist 1; Sen. Rosenwald, Dist 13; Sen. Soucy, Dist 18; and Rep. Merchant, Sull 4.

2  Legislation Enacted.  The general court hereby enacts the following legislation:

PART I

Relative to direct primary care referral parity.

1  New Section; Primary Care Referral Parity.  Amend RSA 420-J by inserting after section 6-e the following new section:

420-J:6-f Referrals and Orders from Certified Direct Primary Care Providers. The department shall review direct primary care agreements submitted by direct primary care providers and shall certify the first 10 which it determines to be fully compliant with the provisions of RSA 329:1-e.  A health benefit plan under this chapter shall not deny or reduce payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a certified direct primary care provider who is not a member of the carrier’s provider network, provided it would have covered the same services if ordered by an in-network provider, subject to the following limitations:

I. No payment shall be made to the certified direct primary care provider for primary care services covered by the direct primary care agreement pursuant to RSA 329:1-e, II(f).

II. An insurer shall not apply a deductible, coinsurance, or copayment greater than the applicable deductible, coinsurance, or copayment that would apply to the same health care service if the service was referred or ordered by an in-network participating primary care provider.

III. An insurer may require the direct primary care provider to file a written attestation or a copy of the certified direct primary care agreement to demonstrate that the provider is a direct primary care provider.

IV. Health care services may be subject to utilization review by the insurer.

V. The covered person shall retain the right to choose direct primary care on an elective, self-pay basis; no entity regulated under this chapter shall prohibit a certified direct primary care provider from continuing care on an elective, self-pay basis.

VI. Direct primary care providers shall not be required to contract as participating providers in any network.

VII.  On or before October 1, 2025, the insurance department shall report to the joint legislative oversight committee on health and human services, established in RSA 126-A:13, relative to any change in expenses to insurers and any resultant changes in insurance rates attributable to this section, as well as any other impacts of direct primary care on the insurance market or health care coverage.

2  Repeal.  RSA 420-J:6-f, relative to referrals and orders from certified direct primary care providers, is repealed.

3  Effective Date.  

I. Section 2 of this act shall take effect January 1, 2027.

II. The remainder of this act shall take effect January 1, 2022.

PART II

Relative to in-network retail pharmacies.

1  New Section; Pharmacy Benefits Managers; Prohibited Acts.  Amend RSA 402-N by inserting after section 4 the following new section:

402-N:4-a  Prohibited Acts.  A pharmacy benefit manager shall not, either directly or indirectly:

I.  Prohibit an in-network retail pharmacy from:

(a)  Mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network retail pharmacy provided that confirmation of delivery is obtained.

(b)  Charging a shipping or handling surcharge to an enrollee who requests that the in-network retail pharmacy mail or deliver a prescription drug to the enrollee as an ancillary service provided the enrollee receives a disclosure from the in-network retail pharmacy regarding any surcharge to be charged to the patient for the delivery of a prescription drug, including that the surcharge may not be reimbursable by the plan sponsor or pharmacy benefit manager.

(c)  Offering the ancillary services described in subparagraph I(a) to an enrollee.

II.  Charge an enrollee who uses an in-network retail pharmacy that offers to mail or deliver a prescription drug to an enrollee as an ancillary service a surcharge for the delivery of a prescription drug or copayment that is higher than the surcharge or copayment the enrollee would pay if the enrollee used an in-network retail pharmacy that does not offer to mail or deliver a prescription drug to an enrollee as an ancillary service.

III. For purposes of this section, a retail pharmacy shall not include a “mail-order pharmacy” as defined in RSA 318:1, VII-b.

2  Effective Date.  Part II of this act shall take effect 60 days after its passage.