SB 665 — relative to pharmacy benefits managers, managed care laws, notice of drug pricing options and pharmacy benefit manager business practices.

SB 665-FN - AS AMENDED BY THE SENATE - Page 2 - I.

No pharmacy benefits manager shall act as such without a written agreement between the pharmacy benefits manager and the health carrier.

The written agreement shall be retained as part of the official records of both the health carrier and the pharmacy benefits manager for the duration of the agreement and for 5 years thereafter.

The agreement shall contain all provisions required by this chapter, except insofar as those requirements do not apply to the functions performed by the pharmacy benefits manager.

"Cost-sharingThe amount"written meansagreement theshall amountinclude owed by a covered individual under the termsfollowing: of a health insurance policy or as required by a pharmacy benefit manager.

(a) A statement of duties that the pharmacy benefits manager is expected to perform on behalf of the health carrier.

(b) A statement that the pharmacy benefits manager has a fiduciary duty to health carrier.

(c) A statement that the pharmacy benefits manager shall maintain and make available to the health carrier complete books and records of all transactions performed on behalf of the health carrier.

(d) The instructions for how the pharmacy benefits manager will undertake the duties delegated by the health carrier.

"DiscountedIn price"cases meansin anywhich publiclypharmacy availablebenefits ormanager pharmacy-affiliatedadministers discount,benefits coupon,for ormore savingsthan program100 pricecovered availablelives toin aNew consumerHampshire on behalf of the health carrier, the health carrier shall, at least semi-annually, conduct an on-site or virtual audit of the timeoperations of sale.the pharmacy benefits manager.

IV.4 Pharmacy Benefits Manager Reporting.

"LowestRSA available402-N:6 price"is meansrepealed theand lowestreenacted ofto theread following prices for a prescription medication as determinedfollows: at the time of sale:

(a)402-N:6 ThePharmacy pharmacyBenefits retailManager price;Reporting.

(b) The consumer's cost-sharing amount under insurance or a pharmacy benefit manager arrangement;

or (c) Any discounted price available through the pharmacy or a recognized discount program.

318:47-o Duty to Charge Lowest Available Price.

AEach pharmacistpharmacy orbenefits pharmacymanager employeeshall shall,submit atto the pointcommissioner semi-annually a report containing a list of sale,health determinebenefit plans it administered and the lowestrebates availableit pricecollected forfrom thepharmaceutical prescriptionmanufacturers medicationthat beingwere dispensedattributable andto shallpatient chargeutilization in the consumerstate thatof lowestNew availableHampshire price.during the prior calendar year.

The report submitted to the commissioner shall, at a minimum, include the following information:

(a) The aggregate dollar amount spent on drugs prior to rebates;

(b) The aggregate dollar amount of all rebates that pharmacy benefit manager received from all pharmaceutical manufacturers;

(c) The aggregate dollar amount of all administrative fees that the pharmacy benefit manager received;

(d) The aggregate dollar amount of all health carrier administrative service fees that the pharmacy benefit manager received;

SB 665-FN - AS AMENDED BY THE SENATE - Page 3 - (e) The aggregate dollar amount of all rebates that the pharmacy benefit manager received from all pharmaceutical manufacturers and did not pass through to health plans or health carriers;

(f) The aggregate dollar amount of all administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers and did not pass through to health plans or health carriers;

(g) The aggregate retained rebate percentage;

and (h) Across all of the pharmacy benefit manager’s contractual or other relationships with all health plans or health carriers, the highest aggregate retained rebate percentage, the lowest aggregate retained rebate percentage, and the mean aggregate retained rebate percentage.

TheInformation pharmacistreported orto pharmacythe employeecommissioner pursuant to this section shall informbe theconfidential consumerand ofprotected from disclosure under the lowestcommissioner's availableexamination priceauthority beforeand completingshall thenot transaction.be considered a public record subject to disclosure under RSA 91-A.

Based on this reporting, the commissioner shall make public aggregated data on the overall amount of rebates collected on behalf of covered persons in the state, but shall not release data that identifies a specific health carrier or pharmacy benefit manager.

NoThe insurer,commissioner pharmacyshall benefitprescribe manager,the orformat third-partyof payerthe shallreport restrict,and prohibit,procedure or penalize a pharmacist for disclosingfiling or charging the lowestreport. available price to a consumer.

SBAny 665-FNforms, -templates, ASor INTRODUCEDguidance -regarding Pagethe 2report -required IV.by the section shall be exempt from the requirements of RSA 541-A.

IfIV. a consumer elects to use insurance, despite a lower cash or discount price, the pharmacy shall document the consumer's election at the point of sale.

318:47-pThis Enforcementsection shall not apply to data related to Medicaid, the Medicaid Care Management program, the Ryan White HIV/AIDS program administered by the department of health and Penalties.human services, self-funded plans, the state employee health benefit plan, or any other plan outside the jurisdiction of the commissioner.

5 Pharmacy Benefits Managers;

Authority to Examine and Directly Bill Pharmacy Benefits Managers for Examinations.

RSA 402-N:7 is repealed and reenacted to read as follows:

402-N:7 Authority to Examine and Directly Bill Pharmacy Benefits Managers for Examinations.

AThe violationacts of thisthe subdivisionpharmacy shallbenefits constitutemanager unprofessionalshall conductbe underconsidered RSAthe 318acts andof shall subject the licenseehealth tocarrier disciplinaryon actionwhose bybehalf theit boardis ofacting. pharmacy.

A pharmacy benefits manager may be examined as if it were the health carrier pursuant to RSA 400-A:37 and the commissioner may directly bill a pharmacy benefits manager for the costs of any examination.

The boardcommissioner may imposeinvestigate athe civilacts administrativeof penaltya notpharmacy tobenefits exceedmanager $1,000pursuant forto eachRSA violation.400-A:16.

ConsumersThe pharmacy benefits manager shall notmake beall liablerecords forand anybooks amountof exceedingaccount available to the lowestexaminers availableor priceconsultants atand shall otherwise facilitate the timeperformance of sale.the examination or investigation.

318:47-q6 Rulemaking.New Section;

ThePharmacy boardBenefits ofManager; pharmacy shall adopt rules under RSA 541-A as necessary to implement the provisions of this subdivision, including procedures for verifying compliance, consumer complaints, and enforcement actions.

3Legislative EffectiveIntent. Date.

Amend RSA 402-N by inserting after section 1 the following new section:

SB 665-FN - AS AMENDED BY THE SENATE - Page 4 - 402-N:1-a Legislative Intent.

This chapter is enacted for the purpose of regulating insurance and pharmacy benefits manager practices within the state to the maximum extent permitted by federal law, consistent with prevailing United States Supreme Court precedent.

7 Managed Care Law;

Provider Contract 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.

(3) All claims adjudications, appeals, and utilization review processes shall comply with the requirements of RSA 420-J and rules promulgated thereunder.

(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.] SB 665-FN - AS AMENDED BY THE SENATE - Page 5 - (d) [Repealed.] (e) Grant at least 7 days' advance notice of the initial on-site audit for each audit cycle.

A pharmacy that requests an additional 7 days prior to the commencement of an audit shall be granted 7 additional days.

8 Managed Care Law;

Prescription Drugs.

Amend RSA 420-J:7-b, III-IV to read as follows:

III.

Every health plan that provides prescription drug benefits shall provide written notice in a conspicuous font and size to covered persons affected by deletions to the plan list or plan formulary, provide an explanation of the exception process by which a covered person can access nonformulary medically necessary prescription drugs, and provide a toll-free telephone number through which a covered person can request additional information.

For purposes of this paragraph, covered persons affected by deletions to the plan list or plan formulary shall include those covered persons for whom the health plan has provided coverage for the deleted prescription drugs during the 12-month period immediately prior to the deletion.

Upon notification to covered persons, the health benefit plan shall allow at least [45] 60 days before implementation of any formulary deletions;

provided, however, that advance notice shall not be required if the federal Food and Drug Administration has determined that a prescription drug on the health benefit plan's formulary is unsafe.

For purposes of this section, "conspicuous font and size" shall mean a font that is at least [12] 14 point in size and in an easily legible font.

If a covered person avails himself or herself of the exception process as outlined in 420-J:7-b, II, the medication shall be covered by the health plan until there is a resolution of the exception process.

Any denial of an exceptions request shall be considered an adverse determination.

IV.

Every health benefit plan that provides prescription drug benefits shall maintain, as part of its records, all of the following information, which shall be made available to the commissioner upon request:

(a) [the] The complete drug formulary or formularies of the plan, if the plan maintains a formulary, including a list of the prescription drugs on the formulary of the plan by major therapeutic category with an indication of whether any drugs are preferred over the other drugs.

(b) Documentation regarding any changes to the formulary including the date the formulary was changed and the reason for the change.

(c) The complete maximum allowable cost list for each pharmacy subject to the maximum allowable cost list.

(d) Documentation regarding any changes to the maximum allowable cost list including, but not limited to, the date the maximum allowable cost list was changed and when impacted pharmacies were notified of the change.

9 Managed Care Law;

Retroactive Denials Prohibited;

Exceptions.

Amend RSA 420-J:8-b, III to read as follows:

SB 665-FN - AS AMENDED BY THE SENATE - Page 6 - III.

A health carrier shall notify a health care provider at least 15 days in advance of the imposition of any retroactive denials of previously paid claims.

The health care provider shall have 6 months from the date of notification under this paragraph to determine whether the insured has other appropriate insurance, which was in effect on the date of service.

Notwithstanding the contractual terms between the health carrier and provider, the health carrier shall allow for the submission of a claim that was previously denied by another insurer due to the insured's transfer or termination of coverage.

If the health care provider files an appeal within 15 days of the date of the notice by the health carrier, the recoupment of the previously paid claim shall occur only after the appeal and external review process has concluded.

10 New Subparagraphs;

Standards for Accident and Health Insurance;

Establishing Excess Cost Sharing.

Amend RSA 415-A:7, I by inserting after subparagraph (b) the following new subparagraphs:

(c) “Pharmacy benefits manager” means “pharmacy benefits manager” as defined in RSA 402-N:1, VIII.

(d) “Spread pricing” means the model of drug pricing in which the pharmacy benefit manager charges a health benefit plan a contracted price for drugs, and the contracted price for the drugs differs from the amount the pharmacy benefit manager directly or indirectly pays the pharmacist or pharmacy for the drugs, pharmacist services, or drug and dispensing fees.

11 Standards for Accident and Health Insurance;

Establishing Excess Cost Sharing.

Amend RSA 415-A:7, IV(b) to read as follows:

(b) A civil fine not to exceed [$2,500] $10,000 may be imposed for each violation.

Repeated or continuing violations of the same provision shall constitute separate civil offenses.

12 New Paragraphs;

Standards for Accident and Health Insurance;

Establishing Excess Cost Sharing.

Amend RSA 415-A:7 by inserting after paragraph V the following new paragraphs:

VI.

An insurer providing health coverage as defined in RSA 420-G:2, IX to a group shall disclose at the time the plan is sold how rebates will be treated in accordance with this section and, if a pharmacy benefits manager is used to administer the prescription drug benefit, whether spread pricing is used to compensate the pharmacy benefits manager.

VII.

Nothing in this section shall prohibit the use of spread pricing.

13 New Subdivision;

Drug Pricing Options.

Amend RSA 318 by inserting after section 47-m the following new subdivision:

Drug Pricing Options 318:47-n Notice of Drug Pricing Options.

I.

Every pharmacy licensed in this state shall make reasonable efforts to notify consumers of their right to request the lowest available price for a prescription drug.

Such notice may include, but is not limited to, verbal instruction from pharmacy staff, signage at check out, or printed material available for consumers to read.

SB 665-FN - AS AMENDED BY THE SENATE - Page 7 - II.

A pharmacy shall, upon request of a consumer, inform the consumer of available pricing options for a prescription drug, including the consumer’s cost under the consumer’s insurance plan, the pharmacy’s usual and customary cash price, and any available coupons, discounts, or rebate programs.

14 New Section;

Pharmacy Benefit Manager Business Practices.

Amend RSA 402-N by inserting after section 4-a the following new section:

402-N:4-b Pharmacy Benefit Manager Business Practices.

A health carrier or pharmacy benefit manager shall be prohibited from penalizing, requiring, or providing financial incentives, including variations in premiums, deductibles, copayments, or coinsurance, to covered persons as incentives to use specific retail, mail order pharmacy, or another network pharmacy provider that is an affiliate of the pharmacy benefit manager.

15 Effective Date.

LBA 26-3266 Revised04/15/2026 1/30/26 SB 665-FN- FISCAL NOTE AS INTRODUCEDAMENDED BY THE SENATE (AMENDMENTS #2026-1047s, #2026-1239s, and #2026-1129s) AN ACT requiringrelative pharmacies to chargepharmacy consumersbenefits themanagers, lowestmanaged availablecare pricelaws, fornotice prescriptionof drugs. drug FISCALpricing IMPACT:options and pharmacy benefit manager business practices.

TheFISCAL LegislativeIMPACT: Budget Assistant has determined that this legislation has a total fiscal impact of less than $10,000 in each of the fiscal years 2026 through 2029.

Estimated State Impact FY 2026 FY 2027 FY 2028 FY 2029 Revenue $0 Indeterminable Indeterminable Indeterminable Revenue Fund(s) General Fund Expenditures* $0 $0 $0 $0 Funding Source(s) None Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill Estimated Political Subdivision Impact FY 2026 FY 2027 FY 2028 FY 2029 County Revenue $0 $0 $0 $0 County Expenditures $0 Indeterminable Indeterminable Indeterminable Local Revenue $0 $0 $0 $0 Local Expenditures $0 Indeterminable Indeterminable Indeterminable METHODOLOGY:

This bill revises requirements related to pharmacy benefit managers, including contracting standards, reporting requirements, and restrictions on certain practices, and is exempt from the State Employee Health Benefit Plan.

The Insurance Department states this bill may have an indeterminable impact on state revenue from the insurance premium tax.

The Department indicates that changes to pharmacy benefit manager practices, contracting requirements, and prescription drug pricing may result in increases or decreases in health insurance premiums.

Any such changes in premiums would correspondingly affect insurance premium tax revenue;

however, the magnitude and direction of the impact cannot be determined.

To the extent counties and municipalities purchase health insurance, expenditures may increase or decrease;

however, the impact cannot be quantified.

Office of Professional Licensure and Certification and Insurance Department