relative to pharmacy benefits managers, managed care laws, notice of drug pricing options and pharmacy benefit manager business practices.

The bill's entire focus shifted from requiring pharmacies to charge consumers the lowest available price for prescription drugs to regulating pharmacy benefits managers through written agreements, reporting requirements, and increased penalties. The title changed from 'requiring pharmacies to charge consumers the lowest available price' to 'relative to pharmacy benefits managers, managed care laws, notice of drug pricing options and pharmacy benefit manager business practices.'

The original requirement that pharmacists must determine and charge the lowest available price at point of sale (comparing retail price, insurance cost-sharing, and discount prices) was removed entirely. The original also required documenting when a consumer chose insurance over a lower cash or discount price.

A new section (RSA 402-N:2-a) requires PBMs to have written agreements with health carriers before operating. These agreements must include a statement of duties, a fiduciary duty clause, a books and records requirement, and instructions for performing delegated duties. Health carriers must conduct semi-annual on-site or virtual audits when a PBM administers benefits for more than 100 covered lives in New Hampshire.

PBMs must now submit semi-annual reports to the Insurance Commissioner listing all health benefit plans they administer and the rebates collected from pharmaceutical manufacturers attributable to patient utilization in New Hampshire, including aggregate dollar amounts spent on drugs prior to rebates.

The maximum administrative fine for PBM violations was increased from $2,500 per violation to $10,000 per violation, with each day of non-compliance now counted as a separate violation. The original bill's $1,000 penalty through the Pharmacy Board was removed.

The definition of 'pharmacy benefits manager' in RSA 402-N:1 was expanded to explicitly include wholly or partially owned or controlled subsidiaries of a PBM or licensed health insurer. The previous exclusion for health insurers providing PBM services exclusively to their own insureds was removed.