PHARMACY BENEFITS MANAGERS
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 commissioner of the insurance department.
III. "Health carrier" means "health carrier" as defined in RSA 420-J:3, XXIII.
IV. "Health benefit plan" means "health benefit plan" as defined in RSA 420-J:3, XIX.
V. "Pharmacist" means an individual licensed as a pharmacist by the pharmacy board.
VI. "Pharmacist services" means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.
VII. "Pharmacy" means the place licensed by the pharmacy board in which drugs, chemicals, medicines, prescriptions, and poisons are compounded, dispensed, or sold at retail.
VIII. (a) "Pharmacy benefits manager" means a person, business, or other entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefits manager, that, pursuant to a contract with a health carrier, manages the prescription drug coverage provided by the health carrier, including, but not limited to, providing claims processing services for prescription drugs, performing drug utilization review, processing drug prior authorization requests, adjudication of grievances or appeals related to prescription drug coverage, contracting with network pharmacies, and controlling the cost of covered prescription drugs.
(b) "Pharmacy benefits manager" shall not include any:
(1) Health care facility licensed in this state;
(2) Health care professional licensed in this state;
(3) Consultant who only provides advice as to the selection or performance of a pharmacy benefits manager;
(4) Service provided to the Centers for Medicare and Medicaid Services; or
(5) Health insurer licensed in this state if the health insurer or its subsidiary is providing pharmacy benefits management services exclusively to its own insureds.
IX. "Rebate" means a discount or price concession attributable to the utilization of a prescription drug that is paid by the pharmaceutical manufacturer of the drug directly to a pharmacy benefits manager or health carrier after the pharmacy benefits manager or health carrier processes a claim from a pharmacy for a prescription drug manufactured by such pharmaceutical manufacturer. "Rebate" shall not include bona fide service fees, administrative fees, or any other amount which does not qualify as a rebate under this paragraph.
Source. 2019, 320:2, eff. Jan. 1, 2020.