HB 513-FN - AS INTRODUCED
2023 SESSION
23-0716
05/04
HOUSE BILL 513-FN
AN ACT relative to affordability and safety of clinician administered drugs.
SPONSORS: Rep. McGough, Hills. 12
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill requires a health plan to utilize the lowest cost method of reimbursement for clinician administered drugs and requires a health maintenance organization to cover clinician-administered drugs if the drug cannot reasonably be self-administered and is typically administered by a health care professional. The bill also prohibits a health maintenance organization from requiring that a pharmacy dispense a medication to a patient with the expectation that the patient will transport it to a health care setting for administration by a health care professional.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-0716
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to affordability and safety of clinician administered drugs.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Health Maintenance Organizations; Dispensing of Clinician-Administered Drugs. Amend RSA 420-B by inserting after section 26 the following new section:
420-B:27 Dispensing of Clinician-Administered Drugs.
I. As used in this section, “clinician-administered drug” means an outpatient prescription drug other than a vaccine that:
(a) Cannot reasonably be self-administered by the patient to whom the drug is prescribed or by a non-clinician individual assisting the patient with the self-administration; and
(b) Is typically administered:
(1) By a health care professional authorized under the laws of this state to administer the drug, including when acting under a physician’s delegation and supervision; and
(2) In a physician’s office, hospital outpatient infusion center, or other clinical setting.
II. A health maintenance organization or a third party acting on its behalf shall not refuse to authorize, approve, or pay a provider for a covered clinician-administered drug that was dispensed by any in-network hospital or clinic, provided that:
(a) According to medical standards of care for the patient’s condition, the medication must be provided to the patient more expeditiously than the medication could be provided via any other channel covered by the insurer; and
(b) The dispensing and any associated authorization, approval, or payment occurs consistent with the terms and conditions of similarly situated network participants and according to the benefit offered by the health maintenance organization.
III. Unless otherwise requested in writing by the patient or prescriber, a health maintenance organization, pharmacy benefits manager, or other third party acting on behalf of the health maintenance organization, shall not, by contract, written policy, or written procedure, require that a pharmacy dispense a clinician-administered drug directly to a patient with the expectation or intention that the patient will transport the medication to a health care setting for administration by a health care professional.
2 Effective Date. This act shall take effect January 1, 2024.
23-0716
1/6/23
HB 513-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to affordability and safety of clinician administered drugs.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
METHODOLOGY:
This bill requires a health plan to utilize the lowest cost method of reimbursement for clinician administered drugs and requires a health maintenance organization to cover clinician-administered drugs if the drug cannot reasonably be self-administered and is typically administered by a health care professional. The bill also prohibits a health maintenance organization from requiring that a pharmacy dispense a medication to a patient with the expectation that the patient will transport it to a health care setting for administration by a health care professional.
The Insurance Department assumes, if this bill becomes law, lower cost methods of dispensing clinician administered drugs will be curtailed, and higher cost methods will become more predominant. The Insurance Department’s most recent annual report on health care premium and claim cost drivers shows that specialty pharmacy trends were 14.3% in 2021 and continued to outpace trends for non-specialty drugs, contributing 55% of total pharmacy spending in 2021. The Insurance Department assumes the bill would result in an indeterminable but non-negligible increase in HMO insurance premium costs. This would result in an indeterminable increase in premium tax revenues and an indeterminable general fund expense for federally imposed “defrayal” costs as explained below. County and local expenditures may increase to the extent that they offer fully insured health insurance benefits to their employees.
Defrayal Cost
Under federal regulation at CFR Section 155.170, passage of this bill would likely be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits offered in the Exchange Marketplace. Under this regulation, the state must make payments to defray the cost of the additional required benefits to Qualified Health Plan (QHP) enrollees or issuers. This would represent a general fund expense which is indeterminable at this time. However, under RSA 400-A:39-b, the legislative committee having jurisdiction over this bill may refer the proposed mandated coverage to the Insurance Department which is authorized to retain an external actuarial review of the costs and benefits of the proposed mandate. In this manner, a qualified opinion of the cost could be obtained. In addition, the Centers for Medicare and Medicaid Services (CMS) encourages states to reach out to CMS concerning any state defrayal questions in advance of passing and implementing benefit mandates and to provide QHP issuers in the state ample time to quantify the cost attributable to each additional required benefit and report these calculations to the state.
The Department of Health and Human Services states this legislation does not impose any new requirements upon the Department as physician administered drugs are currently covered. In addition, the bill applies to commercial and private insurance and not the Medicaid program.
AGENCIES CONTACTED:
Departments of Health and Human Services and Insurance
| Date | Body | Type |
|---|---|---|
| Jan. 26, 2023 | House | Hearing |
| Feb. 7, 2023 | House | Hearing |
| Feb. 15, 2023 | House | Hearing |
| March 8, 2023 | House | Exec Session |
| March 15, 2023 | House | Exec Session |
| Nov. 7, 2023 | House | Exec Session |
Jan. 3, 2024: Refer for Interim Study: MA VV 01/03/2024 HJ 1 P. 36
Nov. 16, 2023: Committee Report: Refer for Interim Study 11/08/2023 (Vote 19-0; CC) HC 49 P. 5
Nov. 8, 2023: ==CANCELLED== Executive Session: 11/15/2023 11:00 am LOB 302-304 HC 42
Oct. 17, 2023: ==RECESSED== Executive Session: 11/08/2023 01:30 pm LOB 302-304 HC 42
Sept. 6, 2023: ==RESCHEDULED== Subcommittee Work Session: 09/20/2023 01:15 pm LOB 302-304 HC 36
Aug. 30, 2023: ==CANCELLED== Subcommittee Work Session: 09/06/2023 01:15 pm LOB 302-304
March 15, 2023: Retained in Committee
March 8, 2023: Subcommittee Work Session: 03/15/2023 10:05 am LOB 302-304
March 8, 2023: Executive Session: 03/15/2023 11:00 am LOB 302-304
Feb. 23, 2023: Executive Session: 03/08/2023 01:15 pm LOB 302-304
Feb. 23, 2023: Subcommittee Work Session: 03/08/2023 10:00 am LOB 302-304
Feb. 9, 2023: Public Hearing: 02/15/2023 02:00 pm LOB 302-304
Feb. 3, 2023: ==CANCELLED== Public Hearing: 02/07/2023 02:15 pm LOB 210-211
Feb. 2, 2023: ==CANCELLED== Public Hearing: 02/07/2023 02:15 pm LOB 210-211
Feb. 1, 2023: Public Hearing: 02/07/2023 02:15 pm LOB 210-211
Jan. 18, 2023: Public Hearing: 01/26/2023 11:30 am LOB 302-304
Jan. 11, 2023: Introduced (in recess of) 01/05/2023 and referred to Commerce and Consumer Affairs HJ 3 P. 19