This bill amends existing insurance laws to enhance the calculation of cost-sharing requirements for enrollees by mandating that insurers and pharmacy benefits managers include all amounts paid by the enrollee or on their behalf in the determination of coinsurance, copayments, deductibles, and out-of-pocket maximums. Notably, the bill specifies that this requirement does not apply to prescription drugs with generic alternatives unless prior authorization or specific processes are followed. Additionally, for health savings account-qualified high deductible health plans, the requirement will only take effect after the enrollee meets the minimum deductible as defined by federal law, with exceptions for preventive care. The bill introduces new sections to the Revised Statutes Annotated (RSA) 415, 420-A, and 420-B, aiming for uniformity in cost-sharing calculations across various health insurance policies.

Furthermore, the bill proposes amendments that exclude coverage for prescription drugs with generic alternatives unless prior authorization or appeal is granted, while not addressing the branded biologics market and their biosimilar equivalents. The Department of Administrative Services has indicated that the bill will not affect the State of NH Employee and Retiree Health Benefit Plan, as it operates as a self-funded health plan. Concerns have been raised regarding the potential disruption of actuarial methods used by insurers, which could lead to increased insurance premiums and, consequently, higher insurance premium tax revenue for the state. The overall implications of the bill on the insurance market and premium costs remain uncertain, particularly regarding the sources of any additional cost-sharing subsidies.