This bill allows pharmacies to refuse to fill prescriptions if the reimbursement from the pharmacy benefits manager (PBM) is less than the pharmacy's acquisition cost, explicitly excluding Medicaid and Medicaid care management from this provision. It also introduces new requirements for contracts between pharmacies and PBMs, including the obligation for PBMs to provide information on drug pricing sources and to establish a process for appealing maximum allowable cost pricing disputes. The bill amends RSA 420-J:8 to include provisions that require PBMs to review and adjust maximum allowable costs every 14 days and mandates that pharmacies be informed of the actual maximum allowable cost for each drug.

Additionally, the bill defines "pharmacy services administrative organization" and establishes that failure to comply with contract requirements will be considered a violation of the consumer protection act. It requires these organizations to provide pharmacies with copies of contracts and payment schedules within three days of execution. The bill also includes a new paragraph that clarifies that its provisions do not apply to Medicaid or Medicaid care management. The effective date for this act is set for January 1, 2026.

Statutes affected:
As Amended by the Senate: 420-J:8, 358-A:2