Prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.
Summary
SB 247 amends New Hampshire’s managed care and consumer protection laws to address pharmacy reimbursement practices. The bill allows a pharmacist or pharmacy in a network plan to decline to dispense a brand-name drug, multi-source generic drug, supply, or service when the reimbursement offered by a carrier or pharmacy benefit manager (PBM) is below the pharmacy’s acquisition cost. If a pharmacy declines under this provision, it must direct the patient to contact the carrier or PBM for information on where the prescription can be filled. The bill expressly excludes Medicaid and Medicaid care management from this reimbursement-refusal option and related contract standards.
The bill also strengthens PBM contracting and maximum allowable cost (MAC) transparency requirements. It requires contracts to identify the sources used to calculate reimbursement, creates an appeal process for MAC disputes, requires PBMs to disclose the actual MAC for each drug to contracted pharmacies, and mandates more frequent MAC review and adjustment when prices change. In addition, it adds new consumer protection provisions governing pharmacy services administrative organizations (PSAOs), including a requirement that PSAOs provide pharmacies copies of PBM contracts and amendments within three days and a prohibition on contract terms requiring pharmacies to buy drugs or devices from a specific entity. The act is scheduled to take effect January 1, 2026.
Impact
SB 247 would modify RSA 420-J:8, the state’s managed care law governing pharmacy and pharmacist contracting standards, by creating a right for pharmacies to refuse prescriptions reimbursed below acquisition cost and by expanding PBM transparency, appeal, and pricing review obligations. It also adds a new consumer protection violation under RSA 358-A:2 for PSAOs that fail to comply with the bill’s contract-disclosure and anti-forced-purchasing requirements. The bill would not apply to Medicaid or Medicaid care management, limiting its reach to commercial and other non-Medicaid pharmacy benefit arrangements.
Sentiment
The bill appears generally supportive of independent pharmacies and aimed at addressing concerns about under-reimbursement by PBMs. Its framing suggests a policy response to pharmacy financial pressure and network participation issues, with an emphasis on transparency and fair contracting. No committee transcript or vote record was provided, so there is no recorded opposition or formal vote sentiment in the supplied materials.
Contention
The main points of contention are likely to be the pharmacy right to refuse dispensing when reimbursement is below acquisition cost, the added administrative and disclosure burdens on PBMs and PSAOs, and the exclusion of Medicaid and Medicaid care management from the bill’s protections. Pharmacies and independent pharmacy advocates would likely support the measure, while PBMs, carriers, and possibly PSAOs may object to the operational requirements, pricing disclosures, and limits on network management. The bill also raises potential debate over whether these rules improve access and fairness or instead increase costs and complexity in prescription drug benefit administration.