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SB 247 - AS AMENDED BY THE SENATE
03/27/2025 1401s
2025 SESSION
25-0984
05/11
SENATE BILL
247
AN ACT
prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.
SPONSORS: Sen. Rochefort, Dist 1; Sen. Avard, Dist 12; Sen. Innis, Dist 7; Rep. Cole, Hills. 26; Rep. Spier, Hills. 6
COMMITTEE: Health and Human Services
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AMENDED ANALYSIS
This bill:
I. Permits a pharmacy to decline to fill a prescription if reimbursement from the pharmacy benefits manager is less than the pharmacy's acquisition cost and excludes Medicaid and Medicaid care management from this option and other provider contract standards.
II. Defines pharmacy services administrative organization for purposes of pharmacy and PBM contract requirements; and makes the failure of a pharmacy services administrative organization to comply with such requirements a violation of the consumer protection act.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/27/2025 1401s 25-0984
05/11
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACT
prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Managed Care Law; Pharmacy and Pharmacist Contracting Standards. Amend RSA 420-J:8, XV to read as follows:
XV.(a) All contracts between a carrier or pharmacy benefit manager and a contracted pharmacy shall include:
(1) The sources used by the pharmacy benefit manager to calculate the drug product reimbursement paid for covered drugs available under the pharmacy health benefit plan administered by the carrier or pharmacy benefit manager.
(2) A process to appeal, investigate, and resolve disputes regarding the maximum allowable cost pricing. The process shall include the following provisions:
(A) A provision granting the contracted pharmacy or pharmacist at least 30 business days following the initial claim to file an appeal;
(B) A provision requiring the carrier or pharmacy benefit manager to investigate and resolve the appeal within 30 business days;
(C) A provision requiring that, if the appeal is denied, the carrier or pharmacy benefit manager shall:
(i) Provide the reason for the denial; and
(ii) Identify the national drug code of a drug product that may be purchased by contracted pharmacies at a price at or below the maximum allowable cost; and
(D) A provision requiring that, if an appeal is granted, the carrier or pharmacy benefits manager shall within 30 business days after granting the appeal:
(i) Make the change in the maximum allowable cost; and
(ii) Permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question.
(b) For every drug for which the
health carrier or
pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the
health carrier or
pharmacy benefit manager shall:
(1) Include in the contract with the pharmacy information identifying the national drug pricing compendia or sources used to obtain the drug price data.
(2) Make available to a contracted pharmacy the actual maximum allowable cost for each drug.
(3) Review and make necessary adjustments to the maximum allowable cost for every drug for which the price has changed at least every 14 days.
(c) [Repealed.]
(d) [Repealed.]
(e) A pharmacist or pharmacy in a network plan with a health carrier or pharmacy benefits manager may decline to provide a brand-name drug, multi-source generic drug, supply, or service if the reimbursement amount is less than the acquisition cost paid by the pharmacy or pharmacist. If a pharmacist or pharmacy declines to provide the prescription or service, the pharmacy or pharmacist shall advise the patient to contact the health carrier or pharmacy benefits manager using the contact information on the prescription drug card for information as to where the prescription for the drug, supply, or service may be filled.
2 New Paragraph; Managed Care Law; Provider Contract Standards; Medicaid Exclusion. Amend RSA 420-J:8 by inserting after paragraph XVIII the following new paragraph:
XIX. Nothing in this section shall be construed to apply to Medicaid or Medicaid care management.
3 New Paragraph; Regulation of Business Practices for Consumer Protection; Pharmacy Services Administrative Organizations. Amend RSA 358-A:2 by inserting after paragraph XIX the following new paragraph:
XX. Failure of a pharmacy services administrative organization to adhere to the requirements of this paragraph.
(a) Pharmacy services administrative organizations shall provide the contracted pharmacy a copy of any contract with a pharmacy benefit manager, and amendments, payment schedules, or reimbursement rates, within 3 calendar days after the execution of a contract, or an amendment to a contract, signed on behalf of the independent pharmacy.
(b) Contracts between a pharmacy services administrative organization and a pharmacy shall not require that the pharmacy purchase any drugs and/or medical devices from a specific entity.
(c) In this paragraph, "pharmacy services administrative organization" means an entity operating within the state that contracts with one or more independent pharmacies to provide administrative services to pharmacies and negotiate and enter contracts with third-party payers or pharmacy benefit managers on behalf of pharmacies. A person or entity is a pharmacy services administrative organization under this section if it performs one or more of the following administrative services
on behalf of one or more pharmacies:
(1) Assistance with claims.
(2) Assistance with audits.
(3) Assistance with access to pharmacy networks.
(4) Assistance with interactions between the pharmacy and pharmacy benefits manager.
(5) Centralized payment.
(6) Certification in specialized care programs.
(7) Compliance support.
(8) Setting flat fees for generic drugs.
(9) Assistance with store layout.
(10) Marketing support.
(11) Management and analysis of payment and drug dispensing data.
(12) Provision of resources for retail cash cards.
4 Effective Date. This act shall take effect January 1, 2026.
LBA
25-0984
5/9/25
SB 247- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2025-1401s)
AN ACT
prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.
FISCAL IMPACT:
Estimated State Impact
FY 2025
FY 2026
FY 2027
FY 2028
Revenue
$0
$0
$0
$0
Revenue Fund
None
Expenditures*
Indeterminable
Funding Source
General Fund- Consumer Protection Funds
Appropriations*
$0
$0
$0
$0
Funding Source
None
*Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill
Estimated Political Subdivision Impact
FY 2025
FY 2026
FY 2027
FY 2028
County Revenue
$0
$0
$0
$0
County Expenditures
Indeterminable
Local Revenue
$0
$0
$0
$0
Local Expenditures
Indeterminable
METHODOLOGY:
This bill permits a pharmacy to decline to fill a prescription if reimbursement from the pharmacy
benefits manager is less than the pharmacy's acquisition cost and excludes Medicaid and Medicaid care management from this option and other provider contract standards. The bill also defines pharmacy services administrative organization for purposes of pharmacy and PBM contract requirements; and makes the failure of a pharmacy services administrative organization to comply with such requirements a violation of the consumer protection act.
The bill adds, deletes, or modifies a criminal penalty, or changes statute to which there is a penalty for violation. Therefore, this bill may have an impact on the judicial and correctional systems, which could affect prosecution, incarceration, probation, and parole costs, for the state, as well as county and local governments. A summary of such costs can be found at:
https://gencourt.state.nh.us/lba/Budget/Fiscal_Notes/JudicialCorrectionalCosts.pdf
The Department of Justice indicates this bill would amend RSA 358-A:2 by creating a new delineated unfair or deceptive act of practice that applies to pharmacy services administrative organizations. The new section in RSA 358-A:2 could lead to additional complaints to the attorney general. If those complaints are merited, the number of investigations and enforcement actions brought by the Consumer Protection and Antitrust Bureau would increase. Accordingly, there is a potential fiscal impact on the Department of Justice. Because the number of additional complaints, investigations, and enforcement actions cannot be determined at this time, the amount of the fiscal impact is indeterminate.
If additional complaints, investigations and enforcement actions are significant, additional staff would be needed. The Department has estimated the cost of such staff, including benefits below:
Position
FY 2026*
FY 2027
FY 2028
Assistant Attorney General
$66,000
$133,000
$133,000
Investigative Paralegal
$45,000
$91,000
$94,000
*Amounts for FY 2026 are for ½ year since the effective date is January 1, 2026.
Because the number of potential complaints cannot be determined in advance the number of additional staff that may be needed is unknown. Depending on the number of complaints, the Department estimated cost could range from $100,000 to $500,000. The Department states there would be no impact on state revenue.
AGENCIES CONTACTED:
Judicial Branch, Judicial Council, Department of Justice, Department of Corrections, New Hampshire Association of Counties, and New Hampshire Municipal Association