402-N:1 Definitions. – In this chapter: I. " Claims processing services " means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include: (a) Receiving payments for pharmacist services. (b) Making payments to pharmacists or pharmacies for pharmacist services. II. " Commissioner " means the […]
402-N:2 Registration to do Business; Rulemaking; Penalties. – I. A person or organization shall not establish or operate as a pharmacy benefits manager in this state for health benefit plans without registering with the insurance commissioner under this chapter. II. The commissioner shall adopt rules pursuant to RSA 541-A relative to: (a) Prescribing the […]
402-N:3 Provider Contract Standards for Pharmacy Benefit Managers. – I. All contracts between a carrier or pharmacy benefit manager and a contracted pharmacy shall include: (a) The sources used by the pharmacy benefit manager to calculate the drug product reimbursement paid for covered drugs available under the pharmacy health benefit plan administered by the […]
402-N:4 Prescription Drugs. – I. A pharmacy benefits manager or insurer shall require a contracted pharmacy to charge an enrollee or insured person the pharmacy’s usual and customary price of filling the prescription or the contracted copayment, whichever is less. II. Once it has settled a claim for filling a prescription for an enrollee […]
402-N:4-a Prohibited Acts. – A pharmacy benefit manager shall not, either directly or indirectly: I. Prohibit an in-network retail pharmacy from: (a) Mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network retail pharmacy provided that confirmation of delivery is obtained. (b) Charging a shipping or handling surcharge […]
402-N:5 Complaints Relative to Pharmacy Benefit Managers. – I. Consumers may file a complaint related to a registered pharmacy benefit manager pursuant to RSA 400-A:15-e. II. The commissioner shall adopt rules, pursuant to RSA 541-A, to implement paragraph I. Such rules shall include procedures for addressing complaints, provisions for enforcement, the receipt of complaints […]
402-N:6 Pharmacy Benefits Manager Reporting. – I. Each pharmacy benefits manager shall submit an annual report to the commissioner containing a list of health benefit plans it administered, and the aggregate amount of all rebates it collected from pharmaceutical manufacturers that were attributable to patient utilization in the state of New Hampshire during the […]
402-N:7 Authority to Examine and Directly Bill Pharmacy Benefits Managers for Certain Examinations. – The commissioner may examine and directly bill a pharmacy benefits manager required to be registered under this chapter for the costs of any examination pursuant to RSA 400-A:37 as necessary to determine and enforce compliance with this chapter. In addition, […]
402-N:8 Non-Exclusivity. – Nothing in this chapter shall be interpreted to invalidate or render inapplicable any other provision of Title XXXVII that is otherwise applicable to an entity that qualifies as a pharmacy benefit manager under this chapter. Source. 2019, 320:2, eff. Jan. 1, 2020.
402-N:9 Severability. – If any provision of this chapter or the application of this chapter to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provisions or application, and to this end, the provisions of this […]
