SB 544 amends New Hampshire’s managed care laws, specifically the rules governing prescription drug coverage under health benefit plans. The bill requires health plans that provide prescription drug benefits to give covered persons clearer written notice when drugs are removed from a formulary, including a toll-free number for more information and an explanation of the exception process for medically necessary nonformulary drugs. It also extends the advance notice period for formulary deletions from 45 days to 60 days, increases the required font size for notices from 12-point to 14-point, and provides that if a covered person uses the exception process, the medication must remain covered until that process is resolved. Any denial of an exception request is treated as an adverse determination.
The bill also strengthens recordkeeping requirements for health benefit plans by requiring them to maintain complete formularies, documentation of formulary changes, complete maximum allowable cost lists, and records of changes to those cost lists, all available to the Insurance Commissioner upon request. The fiscal note indicates the measure could increase carrier costs by limiting midyear formulary changes and requiring continued coverage of drugs that might otherwise be removed, with possible downstream effects on premiums and insurance premium tax revenue. The act would take effect 60 days after passage.
Impact
SB 544 would amend RSA 420-J:7-b, the state statute governing managed care prescription drug coverage, by imposing more detailed notice, timing, and documentation requirements on health benefit plans. It would effectively restrict a carrier’s ability to make midyear formulary deletions and require continued coverage during the exception process, while also expanding the information carriers must retain and provide to the Insurance Commissioner. The bill could affect insurers, pharmacy benefits managers, covered persons, and public employers or local governments that purchase health coverage, potentially increasing premium costs if carriers pass along added expenses.
Sentiment
The available context suggests generally supportive intent around consumer protection and prescription drug access, with the bill framed as improving notice and continuity of coverage for patients affected by formulary changes. There is no recorded floor debate or vote history in the provided materials, but the committee and fiscal materials indicate the proposal was treated as a substantive managed care reform rather than a procedural measure. The fiscal note acknowledges possible cost increases and administrative burdens, but the overall presentation is neutral-to-supportive of the policy goals.
Contention
The main points of contention are likely the bill’s impact on insurer flexibility and costs. The Insurance Department notes that limiting midyear formulary changes and requiring coverage to continue until renewal or exception resolution could conflict with existing state and federal exception and notice rules, create implementation difficulties, and increase plan costs. Insurers may object that the bill constrains formulary management and maximum allowable cost practices, while consumer advocates would likely support the stronger notice requirements, longer transition period, and guaranteed coverage during appeals or exceptions.
Relative to the department of health and human services management of social security payments, supplemental security income payments, and veterans benefits for children in foster care.
Human services: medical services; exemption of certain prescription drugs from the medical assistance prior authorization process; provide for. Amends sec. 109h of 1939 PA 280 (MCL 400.109h).