Section Ins 2704.06 - Complaint Process(a) Any pharmacy that fills prescriptions as a covered benefit under a health benefit plan and is adversely affected by the failure of a health carrier or a PBM to comply with RSA 420-J:7-b, X or RSA 415:26 may file a complaint with the commissioner.(b) Complaints alleging violations of RSA 420-J:b, X or RSA 415:26 and received directly from pharmacies or referred from the New Hampshire pharmacy board to the commissioner shall be investigated by the commissioner in accordance with the provisions of RSA 400-A:16.(c) The commissioner shall only investigate substantiated complaints that relate to a fully insured plan within the commissioner's jurisdiction.(d) A "substantiated complaint" means a complaint that includes all the following information:(1) The name, address, and license number of the pharmacy filing the complaint;(2) The name and license number of, and the contact information for, a pharmacist who supports the allegations in the complaint filed;(3) Information concerning the prescription, including the name of the prescription dispensed and the quantity and dose of the prescription dispensed, with units expressed in terms of volume, number of tablets or capsules, weight, or in other measurement;(4) The name of the health carrier and the name of the pharmacy benefits manager, if a pharmacy benefits manager is involved in the prescription claim made by the consumer;(5) A legible copy of the front and back of the consumer's insurance card for prescription benefits;(6) The name of the subscriber to the health benefit plan, if that information is not shown on the consumer's insurance card;(7) The date the pharmacy dispensed the prescription to the consumer;(8) The name of the consumer that requested coverage for the prescription at issue in the complaint; and(9) Written evidence that supports the allegations of violation.(e) The commissioner shall inform the pharmacy if the filed complaint is unsubstantiated and what missing information is needed.(f) The commissioner shall hold any complaint that is not substantiated in pending status for 90 days from the date of the notice described in (e) to allow the pharmacy to submit required missing information. If missing information is not provided within 90 days of the date of the notice described in (e), the complaint that is not substantiated shall be closed.(g) Any consumer may file a complaint with the commissioner. Consumer complaints shall be investigated in accordance with RSA 400-A:15-e.N.H. Admin. Code § Ins 2704.06
Derived From Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12121, Effective 2/24/2017, Expires 2/24/2027.Amended by Volume XL Number 28, Filed July 9, 2020, Proposed by #13059, Effective 6/29/2020, Expires 6/29/2030.