Text to be removed highlighted in red.
1 New Section; Accident and Health Insurance; Applying Patient Assistance for Prescription Drugs to Cost Sharing. Amend RSA 415:18 by inserting after section 415:18-ee the following new section:
415:18-ff Applying Patient Assistance for Prescription Drugs to Cost Sharing.
I. In this section:
(a) "Cost-sharing" means any coinsurance, copayment, deductible or out-of-pocket maximum.
(b) "Independent charity patient assistance program" means a program that meets the standards set out by the United States Department of Health and Human Services Office of Inspector General at 70 FR 70623 and 79 FR 31120.
II. Each insurer that issues or renews any policy of group accident or health insurance which provides coverage for prescription drugs, or which contracts with an entity providing such prescription drug coverage, including but not limited to pharmacy benefit manager companies, shall apply any amounts paid at the time of a claim on behalf of an enrollee by an independent charity patient assistance program to the enrollee's cost sharing requirements, except in the case of a covered prescription drug for which there is a generic alternative, biosimilar, or other covered alternative available.
III. The requirement in paragraph II shall apply when an independent charity patient assistance program funded directly or indirectly by a pharmaceutical manufacturer offers the assistance to the enrollee for the full plan year.
IV. If the assistance payment is not processed in coordination with the enrollee's health insurance coverage at the point of sale, then an insurer or its contracted entity providing prescription drug coverage may require a pharmacy processing an assistance payment from an independent charity patient assistance program on behalf of an enrollee to disclose to the enrollee's insurer:
(a) The name of the enrollee on whose behalf a payment was made;
(b) The name of the covered prescription drug for which the payment was made;
(c) The amount of the payment that was provided; and
(d) Any other terms and conditions that are attached to the assistance program under which payment was made.
V. For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2) or a catastrophic health plan, as defined under the Patient Protection and Affordable Care Act of 2009, a carrier shall be exempt from the provisions of this section until an enrollee's deductible has been satisfied for the year.
2 Effective Date. This act shall take effect on January 1, 2026.
Text to be added highlighted in green.
1 New Section; Accident and Health Insurance; Applying Patient Assistance for Prescription Drugs to Cost Sharing. Amend RSA 415:18 by inserting after section 415:18-ee the following new section:
415:18-ff Applying Patient Assistance for Prescription Drugs to Cost Sharing.
I. In this section:
(a) "Cost-sharing" means any coinsurance, copayment, deductible or out-of-pocket maximum.
(b) "Independent charity patient assistance program" means a program that meets the standards set out by the United States Department of Health and Human Services Office of Inspector General at 70 FR 70623 and 79 FR 31120.
II. Each insurer that issues or renews any policy of group accident or health insurance which provides coverage for prescription drugs, or which contracts with an entity providing such prescription drug coverage, including but not limited to pharmacy benefit manager companies, shall apply any amounts paid at the time of a claim on behalf of an enrollee by an independent charity patient assistance program to the enrollee's cost sharing requirements, except in the case of a covered prescription drug for which there is a generic alternative, biosimilar, or other covered alternative available.
III. The requirement in paragraph II shall apply when an independent charity patient assistance program funded directly or indirectly by a pharmaceutical manufacturer offers the assistance to the enrollee for the full plan year.
IV. If the assistance payment is not processed in coordination with the enrollee's health insurance coverage at the point of sale, then an insurer or its contracted entity providing prescription drug coverage may require a pharmacy processing an assistance payment from an independent charity patient assistance program on behalf of an enrollee to disclose to the enrollee's insurer:
(a) The name of the enrollee on whose behalf a payment was made;
(b) The name of the covered prescription drug for which the payment was made;
(c) The amount of the payment that was provided; and
(d) Any other terms and conditions that are attached to the assistance program under which payment was made.
V. For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2) or a catastrophic health plan, as defined under the Patient Protection and Affordable Care Act of 2009, a carrier shall be exempt from the provisions of this section until an enrollee's deductible has been satisfied for the year.
2 Effective Date. This act shall take effect on January 1, 2026.