SB 247 - AS INTRODUCED 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:

Rochefort,Birdsell, Dist 1;19 March 26, 2025 2025-1401s 05/09 Floor Amendment to SB 247 Amend the bill by replacing all after the enacting clause with the following:

Sen.3 1 Managed Care Law;

Avard,Pharmacy Distand 12;Pharmacist Contracting Standards.

Sen.Amend RSA 420-J:8, XV to read as follows:

Innis,XV.(a) DistAll 7;contracts between a carrier or pharmacy benefit manager and a contracted pharmacy shall include:

Rep.(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.

Cole,(2) Hills.A process to appeal, investigate, and resolve disputes regarding the maximum allowable cost pricing.

26;The process shall include the following provisions:

Rep.(A) A provision granting the contracted pharmacy or pharmacist at least 30 business days following the initial claim to file an appeal;

Spier,(B) Hills.A provision requiring the carrier or pharmacy benefit manager to investigate and resolve the appeal within 30 business days;

6(C) COMMITTEE:A provision requiring that, if the appeal is denied, the carrier or pharmacy benefit manager shall:

Health(i) andProvide Human Services ───────────────────────────────────────────────────────────────── ANALYSIS This bill permits a pharmacy to decline to fill a prescription if reimbursement from the pharmacyreason benefitsfor manager is less than the pharmacy'sdenial; acquisition cost.

Theand bill(ii) alsoIdentify definesthe pharmacynational servicesdrug administrativecode organizationof fora purposesdrug ofproduct pharmacythat andmay PBMbe contractpurchased negotiationby andcontracted administration.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: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Explanation:

Matter(i) addedMake tothe currentchange lawin appearsthe inmaximum boldallowable italics.cost;

Matter removed from current law appears [in brackets and struckthrough.](ii) MatterPermit whichthe ischallenging eitherpharmacy (a) all new or (b)pharmacist repealedto reverse and reenactedrebill appearsthe claim in regularquestion. type.

SB(b) 247For -every ASdrug INTRODUCEDfor 25-0984which 05/11 STATE OF NEW HAMPSHIRE In the Yearhealth ofcarrier Ouror Lordpharmacy Twobenefit Thousandmanager Twentyestablishes Fivea ANmaximum ACTallowable prohibitingcost network exclusion for pharmacies that refuse to dispensedetermine athe prescriptiondrug ofproduct reimbursement, the PBMhealth reimbursementcarrier thator ispharmacy belowbenefit themanager pharmacy'sshall: acquisition cost.

Be(1) itInclude Enactedin bythe contract with the Senatepharmacy andinformation Houseidentifying ofthe Representativesnational indrug Generalpricing Courtcompendia convened:or sources used to obtain the drug price data.

1(2) PharmacyMake Benefitsavailable Managers;to a contracted pharmacy the actual maximum allowable cost for each drug.

PharmacyFloor Opt-outAmendment Whento ReimbursementSB is247 Below- AcquisitionPage Cost.2 - (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.

Amend(c) RSA[Repealed.] 402-N(d) by[Repealed.] inserting(e) afterA sectionpharmacist 4-aor 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 followingreimbursement newamount section:is less than the acquisition cost paid by the pharmacy or pharmacist.

402-N:4-bIf Pharmacya Opt-outpharmacist Whenor Reimbursementpharmacy isdeclines Belowto Acquisitionprovide Cost.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.

I.2 New Paragraph;

AManaged pharmacistCare orLaw; 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.

II.Provider Contract Standards;

IfMedicaid aExclusion. pharmacist or pharmacy declines to provide the prescription or service under the conditions in paragraph I, the pharmacy or pharmacist shall advise the patient to contact their insurance 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.

III.Amend RSA 420-J:8 by inserting after paragraph XVIII the following new paragraph:

AXIX. pharmacy services administrative organization contract with a pharmacy shall include a provision that requires the pharmacy services administrative organization to provide to 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.

IV.Nothing in this section shall be construed to apply to Medicaid or Medicaid care management.

Contracts3 betweenNew aParagraph; pharmacy services administrative organization and pharmacy shall not require that the pharmacy purchase any drugs and/or medical devices from a specific entity.

IfRegulation aof pharmacyBusiness believesPractices thatfor itsConsumer contractProtection; with a pharmacy services administrative organization contains an unlawful contractual provision regarding reimbursement rates or restrictive drug purchasing requirements, the pharmacy may file a complaint with the department.

V.Pharmacy Services Administrative Organizations.

NothingAmend inRSA this358-A:2 sectionby shallinserting preventafter theparagraph customerXIX from paying the differencefollowing betweennew theparagraph: acquisition cost and reimbursement amount if they would prefer to have the prescription filled by that pharmacist or pharmacy.

VI.XX.

InFailure thisof sectiona “pharmacypharmacy services administrative organization”organization means an entity operating within the state that contracts with one or more independent pharmacies to provideadhere administrative services to pharmaciesthe andrequirements negotiate and enter into contracts with third-party payers or pharmacy benefit managers on behalf of pharmacies.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.