Revision: June 5, 2024, 8:14 a.m.
June 4, 2024
2024-2239-CofC
05/08
Committee of Conference Report on SB 555-FN, relative to receipt of pharmaceutical rebates by insurers and pharmacy benefits managers.
Recommendation:
That the Senate recede from its position of nonconcurrence with the House amendment, and concur with the House amendment, and
That the Senate and House adopt the following new amendment to the bill as amended by the House, and pass the bill as so amended:
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, 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.
The signatures below attest to the authenticity of this Report on SB 555-FN, relative to receipt of pharmaceutical rebates by insurers and pharmacy benefits managers.
Conferees on the Part of the Senate Conferees on the Part of the House
_________________________________________ _______________________________________
Sen. Birdsell, Dist. 19 Rep. Hunt, Ches. 14
_________________________________________ _______________________________________
Sen. Avard, Dist. 12 Rep. Burroughs, Carr. 2
_________________________________________ _______________________________________
Sen. Prentiss, Dist. 5 Rep. Spier, Hills. 6
_______________________________________
Rep. Ammon, Hills. 42
2024-2239-CofC
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.