TITLE XII
PUBLIC SAFETY AND WELFARE
Chapter 161-L
NEW HAMPSHIRE RX ADVANTAGE PROGRAM
Section 161-L:1
161-L:1 Definitions. –
In this chapter:
I. "Commissioner" means the commissioner of the department of health and human services.
II. "Covered drugs" means drugs that are on the New Hampshire preferred drug list.
III. "Department" means the department of health and human services.
IV. "Dispensing fee" means a fee for each prescription dispensed by a pharmacy that is paid to the pharmacy.
V. [Repealed.]
VI. "Initial discounted price" for a drug means the price which has been discounted from a pharmacy's usual and customary charge that participating retail pharmacies may charge qualified residents participating in the program for that drug.
VII. "Labeler" means an entity or person that receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale and that has a labeler code from the federal Food and Drug Administration under 21 C.F.R. section 207.20.
VIII. "Participating retail pharmacy" or "retail pharmacy" means a retail pharmacy located in this state, or another business licensed to dispense prescription drugs in this state, that participates in the program.
IX. "Program" means the New Hampshire Rx advantage program established under this chapter.
X. "Qualified resident" means a resident of this state who has a family income equal to or less than 300 percent of the federal poverty level and who self-qualifies as an enrollee in the program. "Qualified resident" also means a resident of this state whose family incurs unreimbursed expenses for prescription drugs that equal 5 percent or more of family income or whose total unreimbursed medical expenses equal 15 percent or more of family income. For purposes of this definition, the cost of drugs provided under this chapter shall be considered an expense incurred by the family for eligibility determination purposes.
XI. "Secondary discounted price" means the initial discounted price minus any further discounts.
XII. "Usual and customary charge" means the charge a pharmacy charges a customer for a prescription drug.
Source. 2007, 297:7, eff. Jan. 1, 2008. 2019, 134:8, I, 9, eff. June 25, 2019.
Section 161-L:2
161-L:2 New Hampshire Rx Advantage Program Established. –
The department shall establish the New Hampshire Rx advantage program. The department may coordinate this program with other programs and may take actions to enhance efficiency, reduce the cost of prescription drugs, and maximize the benefits to the programs and enrollees, including providing the benefits of this program to enrollees in other programs. The components of the program shall be as follows:
I. A drug manufacturer or labeler that sells prescription drugs in this state through any other publicly-supported pharmaceutical assistance program may enter into a rebate agreement with the department for this program. The rebate agreement shall require the manufacturer or labeler to make rebate payments to the state each calendar quarter or according to a schedule established by the department.
II. The commissioner shall negotiate the amount of the rebate required from a manufacturer or labeler in accordance with this paragraph.
(a) The commissioner shall take into consideration the rebate calculated under the Medicaid Rebate Program pursuant to 42 U.S.C. section 1396r-8, the average wholesale price of prescription drugs, and any other information on prescription drug prices and price discounts.
(b) The commissioner shall use the commissioner's best efforts to obtain an initial rebate amount equal to or greater than the rebate calculated under rebates pursuant to 42 U.S.C. section 1396r-8.
(c) With respect to the rebate taking effect no later than October 1, 2009, the commissioner shall use the commissioner's best efforts to obtain an amount equal to or greater than the amount of any discount, rebate, or price reduction for prescription drugs provided to the federal government.
III. Each participating retail pharmacy shall sell covered drugs to qualified residents at the lower of the initial discounted price and the secondary discounted price as such prices are determined by the department pursuant to this chapter.
(a) The department shall establish discounted prices for drugs covered by a rebate agreement and shall promote the use of efficacious and reduced-cost drugs, taking into consideration reduced prices for state and federally-capped drug programs, differential dispensing fees, administrative overhead, and incentive payments.
(b) Beginning July 1, 2008, a participating retail pharmacy shall offer the initial discounted price.
(c) No later than October 1, 2009, a participating retail pharmacy shall offer the secondary discounted price if available.
Source. 2007, 297:7, eff. Jan. 1, 2008.
Section 161-L:3
161-L:3 Retail Pharmacies; Rules; Operation of Program. –
I. The New Hampshire pharmacy board, established in RSA 318, shall adopt rules, pursuant to RSA 541-A, requiring disclosure by participating retail pharmacies to qualified residents relative to the amount of savings provided as a result of the program. The rules shall include protection of any information that is proprietary in nature.
II. The department shall not impose transaction charges under this program on retail pharmacies that submit claims or receive payments under the program.
III. A participating retail pharmacy shall submit claims to the department to verify the amount charged to qualified residents.
IV. On a weekly or biweekly basis, the department shall reimburse a participating retail pharmacy for the difference between the initial discounted price and the secondary discounted price provided to qualified residents under the program.
V. The department shall conduct ongoing quality assurance activities.
VI. The commissioner shall negotiate a per prescription dispensing fee which shall not be less than the medicaid dispensing fee to be paid to participating pharmacies.
Source. 2007, 297:7, eff. Jan. 1, 2008.
Section 161-L:4
161-L:4 Nonparticipating Manufacturers and Labelers. –
I. The names of manufacturers and labelers who do and do not enter into rebate agreements pursuant to this chapter shall be public information. The department shall release such information to health care providers and the public on a regular basis and shall publicize participation by manufacturers and labelers that is of particular benefit to the public.
II. The department may impose prior authorization requirements in the program, as permitted by law, to the extent the department determines it is appropriate to do so in order to encourage manufacturer and labeler participation in the program and if the additional prior authorization requirements remain consistent with the goals of the program and the requirements of the federal Social Security Act, Title XIX.
Source. 2007, 297:7, see effective date note below.
Section 161-L:5
161-L:5 Repealed by 2019, 134:8, II, eff. June 25, 2019. –
Section 161-L:6
161-L:6 Rulemaking. –
The commissioner shall adopt rules pursuant to RSA 541-A, relative to:
I. Procedures for issuing program enrollment cards.
II. Outreach efforts to build public awareness of the program and to maximize enrollment of eligible residents.
III. Content and format of any forms required under this chapter.
IV. Procedures for entering into rebate agreements with drug manufacturers or labelers.
V. Manner of releasing information to the public under RSA 161-L:4.
Source. 2007, 297:7, eff. Jan. 1, 2008.
Section 161-L:7
161-L:7 Annual Report Required. –
The commissioner shall make an annual report beginning January 1, 2009 relative to the enrollment and financial status of the program, including any recommendations for legislation, to the speaker of the house of representatives, the president of the senate, and the governor.
Source. 2007, 297:7, eff. Jan. 1, 2008.