1 New Subdivision; 340B Discounted Drug Purchasing Program; Reporting Requirements. Amend RSA 126-A by inserting after section 106 the following new subdivision:

340B Discounted Drug Purchasing Program; Reporting Requirements

126-A:107 Definitions. In this subdivision:

I. "340B Covered Entity" means an entity described in 42 U.S.C. 256b(a)(4)(L) through 42 U.S.C. 256b(a)(4)(O) that:

(a) Is authorized to participate in the federal 340B Drug Pricing Program under Section 340B of the federal Public Health Service Act; and

(b) Has a service address in the state of New Hampshire as of January 1 of the reporting year.

(c) The term includes any offsite outpatient facility affiliated under the 340B program with an entity described in this subdivision.

II. "340B program" refers to the federal 340B Drug Pricing Program established under 42 U.S.C. 256b.

III. "Charity care" means the unreimbursed cost to a hospital of providing, funding, or otherwise financially supporting health care services:

(a) To a person classified by the hospital as financially indigent or medically indigent on an inpatient or outpatient basis; and

(b) To financially indigent patients through other nonprofit or public outpatient clinics, hospitals, or health care organizations.

IV. "Financially indigent" means an uninsured or underinsured person who is accepted for care with no obligation or a discounted obligation to pay for the services rendered based on the hospital's financial criteria and procedure used to determine if a patient is eligible for charity care. The criteria and procedure must include income levels and means testing indexed to the federal poverty guidelines. A hospital may determine that a person is financially or medically indigent under the hospital's eligibility system after health care services are provided.

V. "Medically indigent" means a person whose medical or hospital bills after payment by third party payors exceed a specified percentage of the patient's annual gross income as determined in accordance with the hospital's eligibility system, and who is financially unable to pay the remaining bill.

126-A:108 340B Drug Pricing Program Reporting.

I. Before April 1 of each year, a 340B covered entity shall report the following information and transactions to the department of health and human services and the attorney general concerning the 340B covered entity's participation in or participation on behalf of the 340B covered entity in the federal 340B program for the previous calendar year:

(a) Name.

(b) Service Address.

(c) 340B Program Identification Number.

(d) Designation of entity type, as specified in 42 U.S.C. 256b(a)(4), of the 340B covered entity.

(e) The aggregate acquisition cost for all prescription drugs obtained under the 340B program and dispensed or administered to patients.

(f) The aggregate payment amount received for all drugs obtained under the 340B program and dispensed or administered to patients.

(g) The aggregate payment made to pharmacies under contract to dispense drugs obtained under the 340B program.

(h) The number of claims for prescription drugs described in subparagraph (e).

(i) How the 340B covered entity uses any savings from participating in the 340B program, including the amount of savings used for the provision of charity care, community benefits, or a similar program of providing unreimbursed or subsidized health care.

(j) The aggregate payments made to any other entity that is not a 340B covered entity and is not a contract pharmacy for managing any aspect of the 340B covered entity's 340B program.

(k) The aggregate payment made for any other administering expense for the 340B program.

(l) The aggregate number of prescription drugs dispensed or administered to patients for which a payment was reported under subparagraph (e).

(m) The percentage of the 340B covered entity's claims that were for prescription drugs obtained under the 340B program.

(n) The number and percentage of low income patients of the 340B covered entity that were served by a sliding fee scale for a prescription drug dispensed or administered under the 340B program.

(o) The 340B covered entity's total operating costs.

(p) The 340B covered entity's total costs for charity care.

(q) A copy of the 340B covered entity's financial assistance policy for the reporting year.

(r) The number of patients sent to collections.

(s) The aggregate number of financially indigent, medical indigent, and low income patients sent to collections.

II. The information required to be reported under paragraph I shall, to the extent feasible, be reported by payer type, including the following:

(a) Commercial.

(b) Medicaid.

(c) Medicare.

(d) Uninsured.

III. The data submitted in the reports required under this section is confidential and is not available for public inspection.

IV. Before November 15 of each year, the department of health and human services shall prepare a report that aggregates the data submitted under paragraph I and:

(a) Submit the report to the speaker of the house of representatives, the senate president, and the house and senate clerk.

(b) Post the report on the department of health and human services website.

V. Using all powers available under RSA 7:19 through RSA 7:32 and any related law, the director of charitable trusts shall review the data submitted pursuant to this subdivision, including information regarding the use of 340B savings and the sending of patients to collections, to evaluate compliance with New Hampshire charitable trust and nonprofit obligations pursuant to RSA 7:24.

VI. In any legal determination as to whether an entity is operating for a bona fide charitable purpose, knowingly sending a substantial number of financially indigent, medically indigent, or low-income patients to collections shall be considered a significant factor in favor of finding that the entity is operating as a for-profit business.

VII. If, after notice and opportunity for hearing under RSA 7:28-c, the director of charitable trusts makes a final determination that a charitable entity is operating primarily as a for-profit business in violation of RSA 7:24, the director shall promptly notify the internal revenue service exempt organizations division of such findings, including supporting documentation.

126-A:109 Penalties.

I. A 340B covered entity that fails to provide the information required under this chapter by the date required shall be subject to a fine of $1,000 per day for which the information is past due.

II. A violation of the intent of the 340B program identified by the director of charitable trusts shall be an unfair or deceptive trade practice under RSA 358-A and subject to all fines and penalties available under RSA 358-A.

2 Effective Date. This act shall take effect January 1, 2027.

1 New Subdivision; 340B Discounted Drug Purchasing Program; Reporting Requirements. Amend RSA 126-A by inserting after section 106 the following new subdivision:

340B Discounted Drug Purchasing Program; Reporting Requirements

126-A:107 Definitions. In this subdivision:

I. "340B Covered Entity" means an entity described in 42 U.S.C. 256b(a)(4)(L) through 42 U.S.C. 256b(a)(4)(O) that:

(a) Is authorized to participate in the federal 340B Drug Pricing Program under Section 340B of the federal Public Health Service Act; and

(b) Has a service address in the state of New Hampshire as of January 1 of the reporting year.

(c) The term includes any offsite outpatient facility affiliated under the 340B program with an entity described in this subdivision.

II. "340B program" refers to the federal 340B Drug Pricing Program established under 42 U.S.C. 256b.

III. "Charity care" means the unreimbursed cost to a hospital of providing, funding, or otherwise financially supporting health care services:

(a) To a person classified by the hospital as financially indigent or medically indigent on an inpatient or outpatient basis; and

(b) To financially indigent patients through other nonprofit or public outpatient clinics, hospitals, or health care organizations.

IV. "Financially indigent" means an uninsured or underinsured person who is accepted for care with no obligation or a discounted obligation to pay for the services rendered based on the hospital's financial criteria and procedure used to determine if a patient is eligible for charity care. The criteria and procedure must include income levels and means testing indexed to the federal poverty guidelines. A hospital may determine that a person is financially or medically indigent under the hospital's eligibility system after health care services are provided.

V. "Medically indigent" means a person whose medical or hospital bills after payment by third party payors exceed a specified percentage of the patient's annual gross income as determined in accordance with the hospital's eligibility system, and who is financially unable to pay the remaining bill.

126-A:108 340B Drug Pricing Program Reporting.

I. Before April 1 of each year, a 340B covered entity shall report the following information and transactions to the department of health and human services and the attorney general concerning the 340B covered entity's participation in or participation on behalf of the 340B covered entity in the federal 340B program for the previous calendar year:

(a) Name.

(b) Service Address.

(c) 340B Program Identification Number.

(d) Designation of entity type, as specified in 42 U.S.C. 256b(a)(4), of the 340B covered entity.

(e) The aggregate acquisition cost for all prescription drugs obtained under the 340B program and dispensed or administered to patients.

(f) The aggregate payment amount received for all drugs obtained under the 340B program and dispensed or administered to patients.

(g) The aggregate payment made to pharmacies under contract to dispense drugs obtained under the 340B program.

(h) The number of claims for prescription drugs described in subparagraph (e).

(i) How the 340B covered entity uses any savings from participating in the 340B program, including the amount of savings used for the provision of charity care, community benefits, or a similar program of providing unreimbursed or subsidized health care.

(j) The aggregate payments made to any other entity that is not a 340B covered entity and is not a contract pharmacy for managing any aspect of the 340B covered entity's 340B program.

(k) The aggregate payment made for any other administering expense for the 340B program.

(l) The aggregate number of prescription drugs dispensed or administered to patients for which a payment was reported under subparagraph (e).

(m) The percentage of the 340B covered entity's claims that were for prescription drugs obtained under the 340B program.

(n) The number and percentage of low income patients of the 340B covered entity that were served by a sliding fee scale for a prescription drug dispensed or administered under the 340B program.

(o) The 340B covered entity's total operating costs.

(p) The 340B covered entity's total costs for charity care.

(q) A copy of the 340B covered entity's financial assistance policy for the reporting year.

(r) The number of patients sent to collections.

(s) The aggregate number of financially indigent, medical indigent, and low income patients sent to collections.

II. The information required to be reported under paragraph I shall, to the extent feasible, be reported by payer type, including the following:

(a) Commercial.

(b) Medicaid.

(c) Medicare.

(d) Uninsured.

III. The data submitted in the reports required under this section is confidential and is not available for public inspection.

IV. Before November 15 of each year, the department of health and human services shall prepare a report that aggregates the data submitted under paragraph I and:

(a) Submit the report to the speaker of the house of representatives, the senate president, and the house and senate clerk.

(b) Post the report on the department of health and human services website.

V. Using all powers available under RSA 7:19 through RSA 7:32 and any related law, the director of charitable trusts shall review the data submitted pursuant to this subdivision, including information regarding the use of 340B savings and the sending of patients to collections, to evaluate compliance with New Hampshire charitable trust and nonprofit obligations pursuant to RSA 7:24.

VI. In any legal determination as to whether an entity is operating for a bona fide charitable purpose, knowingly sending a substantial number of financially indigent, medically indigent, or low-income patients to collections shall be considered a significant factor in favor of finding that the entity is operating as a for-profit business.

VII. If, after notice and opportunity for hearing under RSA 7:28-c, the director of charitable trusts makes a final determination that a charitable entity is operating primarily as a for-profit business in violation of RSA 7:24, the director shall promptly notify the internal revenue service exempt organizations division of such findings, including supporting documentation.

126-A:109 Penalties.

I. A 340B covered entity that fails to provide the information required under this chapter by the date required shall be subject to a fine of $1,000 per day for which the information is past due.

II. A violation of the intent of the 340B program identified by the director of charitable trusts shall be an unfair or deceptive trade practice under RSA 358-A and subject to all fines and penalties available under RSA 358-A.

2 Effective Date. This act shall take effect January 1, 2027.