Text to be removed highlighted in red.
305:1 Pharmacy Benefits Manager Reporting. Amend RSA 402-N:6, I to read as follows:
I. Each pharmacy benefits manager shall submit an annual report to the commissioner containing a list of health benefit plans it administered, and the aggregate amount of all rebates it collected from pharmaceutical manufacturers that were attributable to patient utilization in the state of New Hampshire during the prior calendar year.
305:2 Pharmaceutical Rebates. Amend RSA 415-A:7, III to read as follows:
III. Beginning November 1, 2020 and annually thereafter, an insurer shall file with the commissioner a report in the manner and form determined by the commissioner demonstrating the manner in which the insurer has complied with this section.
(1) Insurers shall employ actuarial and analytical methodologies to estimate the total rebate amount expected to be received from drug manufacturers over a defined period.
(2) The determination of the estimated rebate amount shall account for factors such as historical rebate data, anticipated changes in drug utilization, formulary modifications, and other pertinent variables.
(3) The calculated estimated rebate amount shall adhere to generally accepted actuarial principles and industry best practices to ensure precision and dependability.
(4) The calculation shall be documented and made available for review by the insurance commissioner, upon request.
III-a. This section shall not apply to Medicaid, the Medicaid Care Management Program, the Ryan White HIV/AIDS Program administered by the department of health and human services, or self-funded plans such as the state employee health benefit plan.
305:3 Repeal. 2020, 15:2, relative to the prospective repeal of RSA 415-A:7, is repealed.
305:4 Effective Date. This act shall take effect June 30, 2024.
Approved: July 26, 2024
Effective Date: June 30, 2024
Text to be added highlighted in green.
305:1 Pharmacy Benefits Manager Reporting. Amend RSA 402-N:6, I to read as follows:
I. Each pharmacy benefits manager shall submit an annual or quarterly report to the commissioner containing a list of health benefit plans it administeredaggregate amount of allNovember 1, 2020 March 1, 2025, and annually thereafter, an insurer shall file with the commissioner a report in the manner and form determined by the commissioner demonstrating the manner in which the insurer and/or its contracted entity for pharmacy benefit services has complied with this section. The report shall include at least the following:*
(a) An actuarial certification attesting:
(1) All discounts and rebates received by health insurers were used to reduce costs for policyholders in compliance with paragraph II .
(2) How rebates were remitted in the individual, small, and large group market.
(3) If applied pursuant to subparagraph II(b), an explanation of how remittance was applied to both plan design, based on estimated rebates, and in future plan years to offset premium.
(4) A description of the methodology employed to calculate the estimated rebate amount, for the purpose of applying to plan design.
(b) Methodology for determining estimated rebate amount:
(1) Insurers shall employ actuarial and analytical methodologies to estimate the total rebate amount expected to be received from drug manufacturers over a defined period.
(2) The determination of the estimated rebate amount shall account for factors such as historical rebate data, anticipated changes in drug utilization, formulary modifications, and other pertinent variables.
(3) The calculated estimated rebate amount shall adhere to generally accepted actuarial principles and industry best practices to ensure precision and dependability.
(4) The calculation shall be documented and made available for review by the insurance commissioner, upon request.
III-a. This section shall not apply to Medicaid, the Medicaid Care Management Program, the Ryan White HIV/AIDS Program administered by the department of health and human services, or self-funded plans such as the state employee health benefit plan.
305:3 Repeal. 2020, 15:2, relative to the prospective repeal of RSA 415-A:7, is repealed.
305:4 Effective Date. This act shall take effect June 30, 2024.
Approved: July 26, 2024
Effective Date: June 30, 2024