Revision: June 13, 2024, 4:18 p.m.
SB 555-FN - VERSION ADOPTED BY BOTH BODIES
03/07/2024 0832s
23May2024... 1794h
06/13/2024 2239CofC
2024 SESSION
24-2870
05/08
SENATE BILL 555-FN
AN ACT relative to receipt of pharmaceutical rebates by insurers and pharmacy benefits managers.
SPONSORS: Sen. Avard, Dist 12; Sen. Watters, Dist 4; Sen. Innis, Dist 7; Sen. Birdsell, Dist 19; Sen. Soucy, Dist 18; Sen. Bradley, Dist 3; Sen. Gannon, Dist 23; Sen. Pearl, Dist 17; Sen. Gendreau, Dist 1; Sen. Carson, Dist 14; Sen. Fenton, Dist 10; Rep. Pauer, Hills. 36; Rep. Mooney, Hills. 12
COMMITTEE: Health and Human Services
-----------------------------------------------------------------
AMENDED ANALYSIS
This bill revises the reporting requirements for pharmacy benefits managers and insurers regarding pharmaceutical rebates. The bill also removes prospective repeal of RSA 415-A:7, relative to insurer cost sharing of rebates.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/07/2024 0832s
23May2024... 1794h
06/13/2024 2239CofC 24-2870
05/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to receipt of pharmaceutical rebates by insurers and pharmacy benefits managers.
Be it Enacted by the Senate and House of Representatives in General Court convened:
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, III to read as follows:
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.
3 Repeal. 2020; 15:2, relative to the prospective repeal of RSA 415-A:7, is repealed.
4 Effective Date. This act shall take effect June 30, 2024.
24-2870
Amended 5/28/24
SB 555-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2024-1794h)
AN ACT relative to receipt of pharmaceutical rebates by insurers and pharmacy benefits managers.
FISCAL IMPACT: [ ] State [ ] County [ ] Local [ X ] None
METHODOLOGY:
The Office of Legislative Budget Assistant states this bill, as amended by the House, has no fiscal impact on state, county and local expenditures or revenue.
AGENCIES CONTACTED:
Insurance Department