Bill Text: NH HB657 | 2019 | Regular Session | Enrolled


Bill Title: Relative to prescription drugs under the managed care law.

Spectrum: Bipartisan Bill

Status: (Engrossed) 2019-06-06 - Enrolled Bill Amendment # 2019-2350e: Amendment Adopted Voice Vote 06/06/2019 [HB657 Detail]

Download: New_Hampshire-2019-HB657-Enrolled.html

HB 657 - VERSION ADOPTED BY BOTH BODIES

 

19Mar2019... 0906h

2019 SESSION

19-0801

01/03

 

HOUSE BILL 657

 

AN ACT relative to prescription drugs under the managed care law.

 

SPONSORS: Rep. Butler, Carr. 7; Rep. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. Hennessey, Graf. 1; Sen. Sherman, Dist 24

 

COMMITTEE: Commerce and Consumer Affairs

 

-----------------------------------------------------------------

 

AMENDED ANALYSIS

 

This bill clarifies the law regarding prescription drugs under the managed care law.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

19Mar2019... 0906h 19-0801

01/03

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Nineteen

 

AN ACT relative to prescription drugs under the managed care law.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  Managed Care Law; Prescription Drugs.  Amend RSA 420-J:7-b, II through III to read as follows:

II.  Every health benefit plan that provides prescription drug benefits shall maintain an expeditious exception process, not to exceed 48 hours, by which covered persons may obtain coverage for a medically necessary nonformulary prescription drug or for a nonformulary prescription drug that was available during the previous 12 months.  The exception process shall begin when the prescribing provider has submitted a request with a clinical rationale for the exception to the health benefit plan.  The exception process shall also begin when a covered person has submitted a non-clinical request for access to a drug approved by the federal Food and Drug Administration for treating a specific condition when such drug was available on the formulary during the previous 12 months.  A prescription that requires an exception for coverage shall be considered approved if the exception process exceeds 48 hours.

II-a.  No health benefit plan that provides prescription drug benefits and establishes the specific sequence in which prescription drugs for a medical condition are to be prescribed shall require failure on the same medication on more than one occasion for patients continuously enrolled in the plan.  Nothing in this section shall be construed to prevent a health care provider from prescribing a medication to the same patient on more than one occasion, when he or she determines it is medically appropriate.

III.  Every health plan that provides prescription drug benefits shall [notify] 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 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 point in size and in an easily legible font.  If a covered person avails him 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.

2  Managed Care Law; Prescription Drugs.  Amend RSA 420-J:7-b, IX(a) to read as follows:

IX.(a)  Every health benefit plan that provides prescription drug benefits shall allow its covered persons to obtain an emergency prescription for up to a 72-hour supply of covered prescription drugs on the covered person's health benefit plan formulary or a prescription drug that was deleted from the formulary within the last 90 days in the event a prescription requires prior authorization or an exception by an insurance carrier and the prior authorization or exception has neither been approved nor denied and a pharmacist has determined the medication is essential as provided in RSA 318:47-i.  Such reimbursement shall be according to the payment rates of the provider contract.  If authorization or exception is subsequently denied, the carrier shall reimburse the pharmacist for the prescription as given based on the pro-rated amount they would have otherwise received under the terms of the provider contract.

3  Effective Date.  This act shall take effect 60 days after its passage.

2  Effective Date.  This act shall take effect 60 days after its passage.

 

LBAO

19-0801

Amended 5/8/19

 

HB 657- FISCAL NOTE

AS AMENDED BY THE HOUSE (AMENDMENT #2019-0906h)

 

AN ACT relative to prescription drugs under the managed care law.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

Indeterminable

Indeterminable

Indeterminable

Indeterminable

   Expenditures

$0

$0

$0

$0

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [    ] Other

 

METHODOLOGY:

This bill establishes an exception for non formulary prescription drugs which were recently on a plan's formulary.  The Insurance Department assumes that the bill may cause some inflationary pressure on claim costs since the formulary was structured to provide lower cost alternatives.  The Department's consideration of the fiscal impact includes only the possible impact on insurance premium tax revenue.

 

The Department of Health of Humans Services states the bill is not applicable to Managed Care Programs and will have no fiscal impact to the Department.

 

AGENCIES CONTACTED:

Insurance Department and Department of Health and Human Services

 

feedback