Relative to Medicaid pharmaceutical services and relative to standing orders for Ivermectin.
Summary
SB 119 would change how New Hampshire Medicaid pays for pharmaceuticals and certain related medical items. The bill directs pharmacists to dispense brand-name drugs to Medicaid beneficiaries when those brand-name drugs are on the Department of Health and Human Services’ preferred drug list, rather than automatically substituting a generic equivalent. The stated policy goal is to improve access to medically necessary drugs while maximizing the program’s net cost savings through manufacturer rebates and a more standardized preferred drug list.
The bill also authorizes the department’s chief medical officer to create standing orders for certain Medicaid-covered over-the-counter medications, medical supplies, and laboratory tests when they are medically necessary and cost effective. Those standing orders would be reviewed annually, and the bill provides liability protection for health care professionals acting in good faith under the standing order authority. The act would take effect July 1, 2025.
Impact
SB 119 would amend RSA 126-A:3, V to create an exception to the current Medicaid generic-substitution preference by requiring brand-name dispensing when the brand-name product is on the Medicaid preferred drug list. It would also limit prior authorization for generic drugs in Medicaid fee-for-service cases, except where the drug utilization review board recommends clinical review for safety or appropriateness. In addition, it would add a new paragraph authorizing standing orders for certain Medicaid-covered non-legend medications, supplies, and laboratory tests, and would shield providers from civil, criminal, and disciplinary liability for actions taken in good faith under that authority.
Sentiment
The bill appears to have support from the Department of Health and Human Services, which requested the legislation and described it as a way to improve access and lower net Medicaid drug costs through rebates and better use of the preferred drug list. The fiscal note is also favorable to the bill’s premise, projecting net savings to the Medicaid program over time despite higher upfront brand-name drug spending. Legislative votes shown in the context suggest the measure or related procedural questions drew meaningful support but also substantial opposition, indicating a divided response rather than broad consensus.
Contention
The main point of contention is the bill’s reversal of the usual Medicaid preference for generics. Supporters argue that some brand-name drugs can have a lower net cost after rebates and that a more standardized preferred drug list can improve access and streamline prescribing. Opponents are likely concerned about mandating brand-name dispensing, the effect on generic substitution practices, and the scope of the standing-order authority. The caption’s reference to standing orders for ivermectin suggests that the standing-order provision may have been especially controversial, even though the bill text itself frames the authority more broadly for over-the-counter medications, supplies, and lab tests.