New Hampshire 2025 Regular Session

New Hampshire Senate Bill SB119 Compare Versions

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1	1	SB 119-FN - AS INTRODUCED
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7	7	2025 SESSION
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9	9	25-0362
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11	11	05/06
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15	15	SENATE BILL119-FN
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19	19	AN ACTrelative to Medicaid pharmaceutical services.
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23	23	SPONSORS:Sen. Gray, Dist 6
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27	27	COMMITTEE:Health and Human Services
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35	35	ANALYSIS
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39	39	This bill directs pharmacists to dispense brand name drugs to Medicaid beneficiaries when the brand name drug is on the department of health and human services preferred drug list. The bill also directs the department to develop a standing order for certain Medicaid-covered, over-the-counter medications, medical supplies, and laboratory tests when deemed medically necessary and cost effective by the department.
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43	43	The bill is a request of the department of health and human services.
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51	51	Explanation:Matter added to current law appears in bold italics.
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53	53	Matter removed from current law appears [in brackets and struckthrough.]
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55	55	Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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57	57	25-0362
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59	59	05/06
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63	63	STATE OF NEW HAMPSHIRE
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67	67	In the Year of Our Lord Two Thousand Twenty Five
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71	71	AN ACTrelative to Medicaid pharmaceutical services.
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75	75	Be it Enacted by the Senate and House of Representatives in General Court convened:
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79	79	1 Purpose and findings. The general court hereby finds that:
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81	81	I. The state of New Hampshire has a substantial interest in ensuring that the Medicaid program is able to provide beneficiaries the greatest access possible to necessary pharmaceutical products. A means of achieving access is to attain best net cost possible on pharmaceutical products.
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83	83	(a) The net cost of a pharmaceutical product is determined by subtracting the pharmaceutical manufacturer rebate revenue the Medicaid program receives from the total drug cost.
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85	85	(b) The department of health and human services will continue to optimize its Medicaid preferred drug list to provide Medicaid beneficiaries with medically necessary access to pharmaceutical products.
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87	87	(c) Collectively, this will allow for the lowest net cost and improve access to therapies and streamline prescribing for providers through a more standardized preferred drug list across all Medicaid pharmacy programs.
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89	89	II. Accordingly, the general court finds that, RSA 126-A:3, V must be amended to remove any barriers to these policy goals.
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91	91	2 Department of Health and Human Services; General Provisions. Amend RSA 126-A:3, V to read as follows:
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93	93	V. Pharmacists shall substitute generically equivalent drug products for all legend and non-legend prescriptions paid for by the department of health and human services, [including the Medicaid program,] unless the prescribing practitioner specifies that the brand name drug product is medically necessary. Such notification shall be in the practitioner's own handwriting or as otherwise authorized by law or regulation and shall be retained [in the pharmacist's file] by the pharmacy. Pertaining to Medicaid, pharmacists shall dispense brand name drug products to Medicaid beneficiaries when the brand name drug product is listed on the department’s Medicaid preferred drug list, and not substitute generically equivalent drugs. The provisions of paragraph III shall not apply to the dispensing by a pharmacy for medical assistance reimbursement for legend and non-legend drugs. The commissioner, in consultation with pharmacy providers, shall establish medical assistance reimbursement for legend and non-legend drugs. For Medicaid fee for service [clients] beneficiaries, no prior authorization [for generically equivalent drugs shall be required] shall be required for generic drug products unless the drug class is recommended by the drug utilization review board for clinical appropriateness and safety utilization review.
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95	95	3 New Paragraph; Department of Health and Human Services; General Provisions. Amend RSA 126-A:3 by inserting after paragraph V the following new paragraph:
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97	97	V-a.(a) When deemed medically necessary and cost effective by the department of health and human services’ chief medical officer, a standing order may be issued by the chief medical officer for certain Medicaid covered over-the-counter (non-legend) medications, medical supplies, and laboratory tests. Such standing order shall be reviewed annually by the chief medical officer for continuation or discontinuation of the standing order.
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99	99	(b) No health care professional, acting in good faith and with reasonable care, who issues a standing order, or who dispenses, or distributes over-the-counter (non-legend) medications, medical supplies, or laboratory tests by standing order shall be subject to any criminal or civil liability, or any professional disciplinary action, for any action authorized by this paragraph or any outcome resulting from an action authorized by this paragraph.
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101	101	4 Effective Date. This act shall take effect July 1, 2025.
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105	105	LBA
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107	107	25-0362
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109	109	Revised 2/17/25
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113	113	SB 119-FN- FISCAL NOTE
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115	115	AS INTRODUCED
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119	119	AN ACTrelative to Medicaid pharmaceutical services.
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123	123	FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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126	126	Estimated State Impact
127	127	FY 2025 FY 2026 FY 2027 FY 2028
128	128	Revenue $0 $12,700,000 $38,100,000 $50,800,000
129	129	Revenue Fund(s) Pharmacy Rebate Revenue
130	130	Expenditures* $0 ($1,100,000) ($3,400,000) ($4,500,000)
131	131	Funding Source(s) General and other funds.
132	132	Appropriations* $0 $0 $0 $0
133	133	Funding Source(s) None
134	134	Expenditure = Cost of bill Appropriation = Authorized funding to cover cost of bill
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140	140	Estimated State Impact
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144	144	FY 2025
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146	146	FY 2026
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148	148	FY 2027
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150	150	FY 2028
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152	152	Revenue
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154	154	$0
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156	156	$12,700,000
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158	158	$38,100,000
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160	160	$50,800,000
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162	162	Revenue Fund(s)
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164	164	Pharmacy Rebate Revenue
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166	166	Expenditures*
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168	168	$0
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170	170	($1,100,000)
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172	172	($3,400,000)
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174	174	($4,500,000)
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176	176	Funding Source(s)
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178	178	General and other funds.
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180	180	Appropriations*
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182	182	$0
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184	184	$0
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188	188	$0
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190	190	Funding Source(s)
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192	192	None
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194	194	Expenditure = Cost of bill Appropriation = Authorized funding to cover cost of bill
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198	198	METHODOLOGY:
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200	200	This bill directs pharmacists to dispense brand name drugs to Medicaid beneficiaries when the brand name drug is on the Department of Health and Human Services preferred drug list. The bill also directs the Department to develop a standing order for certain Medicaid-covered, over-the counter medications, medical supplies, and laboratory tests when deemed medically necessary and cost effective by the Department.
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204	204	The Department of Health and Human Services indicates this bill would result in net savings to the Medicaid program for the coverage of pharmaceutical drugs. The Department actuaries estimate the up-front cost to purchase brand name drugs over generics will be offset by increased rebate revenue to result net savings of in $1.1 million FY 2026, $3.4 million in FY 2027 and $4.5 million in FY 2028. Currently, RSA 126-A:3, V requires the Medicaid program to prioritize coverage for generic drug products over brand name drug products unless the brand name is specified as medically necessary by a prescribing provider. The Department may enter into rebate agreements with manufacturers of brand name drug products which may result in the brand name drug product having a lower net cost than the generically equivalent drug product. Net cost is determined by subtracting pharmaceutical manufacturer rebate revenue from the total drug cost.
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208	208	The Department’s contracted actuaries conducted an analysis of the drug products paid for by the Medicaid program that, under this bill, could be shifted from generic equivalents to brand names and the potential cost savings that might occur.
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218	218	Section 3 of the bill provides the Department with the ability to achieve savings by taking advantage of market conditions and more quickly adapting to advances in medical care and treatment which will result in additional cost savings. This provision gives the Chief Medical Officer the ability to write standing orders for over-the-counter medications, medical supplies and laboratory tests where doing so would result in cost savings to the Medicaid program.
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222	222	AGENCIES CONTACTED:
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224	224	Department of Health and Human Services