New Hampshire 2025 Regular Session

New Hampshire Senate Bill SB17 Compare Versions

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Version 2 (New)

Old	New	Differences
1	1	SB 17-FN - AS AMENDED BY THE SENATE
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5	5	03/06/2025 0531s
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7	7	2025 SESSION
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9	9	25-0269
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11	11	05/08
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15	15	SENATE BILL17-FN
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19	19	AN ACTrelative to insurance cost-sharing calculations.
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23	23	SPONSORS:Sen. Innis, Dist 7
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27	27	COMMITTEE:Health and Human Services
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31	31	-----------------------------------------------------------------
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35	35	AMENDED ANALYSIS
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39	39	This bill requires an insurer to apply an amount paid by a third party, including an independent charity, to the enrollee's cost sharing requirements, except in the case of a covered prescription drug for which there is a generic alternative or interchangeable biological product.
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43	43	- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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47	47	Explanation:Matter added to current law appears in bold italics.
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49	49	Matter removed from current law appears [in brackets and struckthrough.]
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51	51	Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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53	53	03/06/2025 0531s25-0269
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55	55	0508/
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59	59	STATE OF NEW HAMPSHIRE
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63	63	In the Year of Our Lord Two Thousand Twenty Five
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67	67	AN ACTrelative to insurance cost-sharing calculations.
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71	71	Be it Enacted by the Senate and House of Representatives in General Court convened:
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75	75	1 New Section; Accident and Health Insurance; Applying Patient Assistance for Prescription Drugs to Cost Sharing. Amend RSA 415:18 by inserting after section 415:18-ee the following new section:
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77	77	415:18-ff Applying Patient Assistance for Prescription Drugs to Cost Sharing.
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79	79	I. In this section:
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81	81	(a) “Cost-sharing” means any coinsurance, copayment, deductible or out-of-pocket maximum.
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83	83	(b) "Interchangeable biological product" means a biological product that the federal Food and Drug Administration:
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85	85	(1) Has licensed and determined meets the standards for interchangeability pursuant to 42 U.S.C. section 262(k)(4); or
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87	87	(2) Has determined is therapeutically equivalent as set forth in the latest edition of or supplement to the federal Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations.
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89	89	II. Each insurer that issues or renews any policy of individual or group accident or health insurance which provides coverage for prescription drugs, or which contracts with an entity providing such prescription drug coverage, including but not limited to pharmacy benefit manager companies, shall apply any amounts paid at the time of a claim on behalf of an enrollee by a third party, including but not limited to an independent charity, to the enrollee’s cost sharing requirements, except in the case of a covered prescription drug for which there is a generic alternative or interchangeable biological product.
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91	91	III. If the assistance payment is not processed in coordination with the enrollee’s health insurance coverage at the point of sale, then an insurer or its contracted entity providing prescription drug coverage may require a pharmacy processing an assistance payment from an independent charity patient assistance program on behalf of an enrollee to disclose to the enrollee’s insurer:
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93	93	(a) The name of the enrollee on whose behalf a payment was made;
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95	95	(b) The name of the covered prescription drug for which the payment was made;
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97	97	(c) The amount of the payment that was provided; and
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99	99	(d) Any other terms and conditions that are attached to the assistance program under which payment was made.
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101	101	IV. For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2) or a catastrophic health plan, as defined under the Patient Protection and Affordable Care Act of 2009, a carrier shall be exempt from the provisions of this section until the enrollee has satisfied the minimum deductible under Section 223 of the Federal Internal Revenue Code.
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103	103	2 Effective Date. This act shall take effect on January 1, 2026.
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107	107	LBA
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109	109	25-0269
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111	111	12/18/24
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115	115	SB 17-FN- FISCAL NOTE
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117	117	AS INTRODUCED
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121	121	AN ACTrelative to insurance cost-sharing calculations.
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125	125	FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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128	128	Estimated State Impact
129	129	FY 2025 FY 2026 FY 2027 FY 2028
130	130	Revenue $0 Indeterminable Increase Indeterminable Increase Indeterminable Increase
131	131	Revenue Fund(s) General Fund Insurance Premium Tax Revenue
132	132	Expenditures* $0 $0 $0 $0
133	133	Funding Source(s) None
134	134	Appropriations* $0 $0 $0 $0
135	135	Funding Source(s) None
136	136	Expenditure = Cost of bill Appropriation = Authorized funding to cover cost of bill
137	137	Estimated Political Subdivision Impact
138	138	FY 2025 FY 2026 FY 2027 FY 2028
139	139	County Revenue $0 $0 $0 $0
140	140	County Expenditures $0 Indeterminable Increase Indeterminable Increase Indeterminable Increase
141	141	Local Revenue $0 $0 $0 $0
142	142	Local Expenditures $0 Indeterminable Increase Indeterminable Increase Indeterminable Increase
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148	148	Estimated State Impact
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152	152	FY 2025
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154	154	FY 2026
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156	156	FY 2027
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158	158	FY 2028
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160	160	Revenue
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162	162	$0
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164	164	Indeterminable Increase
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166	166	Indeterminable Increase
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168	168	Indeterminable Increase
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170	170	Revenue Fund(s)
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172	172	General Fund Insurance Premium Tax Revenue
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174	174	Expenditures*
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176	176	$0
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178	178	$0
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180	180	$0
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182	182	$0
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184	184	Funding Source(s)
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186	186	None
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188	188	Appropriations*
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190	190	$0
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192	192	$0
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194	194	$0
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196	196	$0
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198	198	Funding Source(s)
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200	200	None
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202	202	Expenditure = Cost of bill Appropriation = Authorized funding to cover cost of bill
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206	206	Estimated Political Subdivision Impact
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210	210	FY 2025
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212	212	FY 2026
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214	214	FY 2027
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216	216	FY 2028
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218	218	County Revenue
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220	220	$0
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222	222	$0
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224	224	$0
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226	226	$0
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228	228	County Expenditures
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230	230	$0
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232	232	Indeterminable Increase
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234	234	Indeterminable Increase
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236	236	Indeterminable Increase
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238	238	Local Revenue
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240	240	$0
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242	242	$0
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244	244	$0
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246	246	$0
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248	248	Local Expenditures
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250	250	$0
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252	252	Indeterminable Increase
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254	254	Indeterminable Increase
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256	256	Indeterminable Increase
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260	260	METHODOLOGY:
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262	262	This bill provides that, when calculating an enrollee's contribution to cost-sharing requirements, the insurer or pharmacy benefits manager shall include any amount paid by the enrollee or paid on their behalf. The bill includes a limited exception for health savings account-qualified high deductible health plans if application of the requirement would result in account ineligibility under the Internal Revenue Code.
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266	266	The Insurance Department indicates this bill, if enacted, would amend RSAs 415, 420-A, and 420-B by requiring that when insurers or pharmacy benefit managers (PBM) calculate an enrollee’s contribution to cost-sharing requirements both the amount paid by the enrollee and amounts paid on behalf of the enrollee are included except in the case that qualified high deductible health plans would be ineligible if this requirement is applied. This provision applies to both medical and pharmacy benefits. Prescription drugs for which there is a generic alternative would also be excluded unless approval based on prior authorization or appeal applies.
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270	270	The Department acknowledges that the language in the bill considers prescription drugs (e.g., small molecule drugs) and their respective generic equivalents. However, the bill does not specifically recognize the branded biologics market and its biosimilar equivalents, which are often branded as well. Across a continuum of prescription drugs, the latter substances may be more likely to be associated with manufacturer co-pay assistance coupons, as they are usually higher-cost drugs. The Department states that insurers employ precise actuarial methods to estimate premium costs, based on the previous years’ claims experience. These estimates are used to design plans to achieve an optimal balance of premium and cost sharing attributes to meet a myriad of market characteristics. If extraneous revenue sources are applied to assisting enrollees in meeting their cost-sharing responsibilities, and/or these costs are met with non-real dollars, this would disrupt the economics of cost-estimation among the affected health insurers, and consequently, drive premiums upward. The extent of the increased premium pressure is indeterminable at this time, as the sources of the extraneous cost sharing subsidies is not tractable. An increase in insurance premiums will lead to an increase in insurance premium tax revenue to the state general fund and increased expenditures to county and local governments to the extent these entities pay insurance premiums for health and pharmacy benefits.
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274	274	The Department of Administrative Services indicates that because RSA 415, RSA 420-A and RSA 420-B only apply to fully insured commercial health insurance plans, the impact on the State of NH Employee and Retiree Health Benefit Plan (HBP) would be zero. The HBP is a self-funded health plan covering participants eligible for the active employee HBP and the nonMedicare Retiree HBP where the cost of claims is paid by the State. The Medicare eligible Retiree Health Benefit Plan is a fully insured Medicare Advantage with Prescription Drug (MA-PD) plan that is governed by the laws and rules of the federal Centers for Medicare and Medicaid Services (CMS). Therefore, the State HBP is not governed by the laws of NH Insurance Department.
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278	278	AGENCIES CONTACTED:
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280	280	Departments of Insurance and Administrative Services