Revision: Feb. 21, 2024, 4:28 p.m.
Health and Human Services
February 21, 2024
2024-0832s
05/02
Amendment to SB 555-FN
Amend the bill by replacing all after the enacting clause with the following:
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 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. This paragraph 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. The report submitted to the commissioner shall include the following information:
(a) The aggregate number of rebates and total value received by the pharmacy benefit manager;
(b) The aggregate number of rebates and total value distributed to the appropriate health care insurer;
(c) The aggregate number of rebates and total value passed on to an insured of each health care insurer at the point of sale that reduced the insured’s applicable deductible, copayment, coinsurance, or other cost-sharing amount;
(d) The individual and aggregate amount paid by the health care insurer to the pharmacy benefit manager for pharmacist services itemized by pharmacy, by product (at the unique NDC level), and by goods and services; and
(e) The individual and aggregate amount a pharmacy benefit manager paid for pharmacist services itemized by pharmacy, by product, and by goods and services.
2 Pharmaceutical Rebates. Amend RSA 415-A:7, II-IV to read as follows:
II. All rebates remitted by or on behalf of a pharmaceutical manufacturer, developer, or labeler, directly or indirectly, to an insurer, or to a pharmacy benefits manager under contract with an insurer, related to its prescription drug benefits shall be remitted in [one or both of] the following ways:
(a) At least 50 percent of all rebates shall be remitted directly to the covered person at the point of sale to reduce the out-of-pocket cost to the covered person associated with a particular or specific prescription drug;
(b) Remitted to, and retained by, the insurer. The remainder of the rebates remitted to the insurer shall be applied by the insurer in its plan design and in future plan years to offset the premium for covered persons.
III. Beginning [November 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.
IV. Any insurer that violates any provision of this section may, at the discretion of the commissioner, be subject to subparagraph (a) or (b), or both:
(a) Its certificate of authority may be indefinitely suspended or revoked.
(b) A civil fine not to exceed [$2,500] $10,000 may be imposed for each violation. Repeated violations of the same provision shall constitute separate civil offenses.
3 Repeal. 2020; 15:2, relative to the prospective repeal of RSA 415-A:7, is repealed.
I. Section 3 of this act shall take effect June 30, 2024.
II. The remainder of this act shall take effect 60 days after its passage.