Section Pdab 301.01 - Powers and Duties of Board(a) In consultation with the advisory council, the board shall identify strategies that optimize spending by public payors for pharmaceutical products while reasonably ensuring subscriber access to needed pharmaceutical products.(b) To achieve (a) above, the board shall determine annual spending targets for prescription drugs purchased by public payors using the following: (1) A 10-year rolling average of the medical care services component of the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index available at;(2) Plus a percentage for inflation; and(3) An adjusted spending target based on projected savings as determined by the board which might include drug rebates, lower medical costs, and drug utilization.(c) The board shall determine spending targets on specific prescription drugs that might cause affordability challenges to enrollees in a public payor health plan. Such targets shall consider any medical cost offsets achieved by utilization of the drug.(d) The board shall determine which public payors are likely to exceed the spending targets determined in (b) above.(e) The board shall consider the following data to accomplish its duties in (a) through (d) of this section, including but not limited to:(1) Expenditures and utilization data for prescription drugs for each plan offered by a public payor;(2) The formulary for each plan offered by a public payor and prescription drugs common to each formulary;(3) Pharmacy benefit management services and other administrative expenses of the prescription drug benefit for each plan offered by a public payor;(4) Enrollee cost sharing for each plan offered by a public payor;(5) Aggregate net spending on the prescription drug benefit;(6) Data compiled by the department of health and human services; and(7) Claims databases, including but not limited to the all payors claims database, New Hampshire comprehensive health information system (NH-CHIS), all prescription drug spending whether billed under the prescription drug benefit or the medical benefit.(f) Prescription drug spending data provided to the board under this section shall be confidential to the same extent it is confidential while in the custody of the entity that provided the data to the board;(g) Based upon the prescription drug spending data received in accordance with (e) above, the board, in consultation with a representative of each public payor shall determine methods for the public payor to meet the spending targets established in (a) through (d).(h) While continuing to ensure adequate access by subscribers to needed prescribed pharmaceutical products, the board shall determine whether the following methods reduce costs to individuals purchasing prescription drugs through a public payor and allow public payors to meet the spending targets established in (a) through (d): (1) Negotiating specific rebate amounts on the prescription drugs that contribute most to spending that exceeds the spending targets;(2) Changing a formulary when sufficient rebates cannot be secured under (1);(3) Establishing a common prescription drug formulary for all public payors;(4) Prohibiting health insurance carriers in the state administering benefits for a public payor from offering on their formularies prescription drugs when the method described in (2) is implemented;(5) Purchasing prescription drugs in bulk or through a single purchasing agreement for use among public payors;(6) Collaborating with other states and state prescription drug purchasing consortia to purchase prescription drugs in bulk or to jointly negotiate rebates;(7) Allowing health insurance carriers providing coverage to small businesses and individuals in the state to participate in the public payor prescription drug benefit for a fee; and(8) Procuring common expert services for public payor, including but not limited to pharmacy benefit management services and actuarial services.(i) By November 1 of each year the board shall report its recommendations, including prescription drug spending targets, its strategies for optimization of affordability of prescription drugs for the state and all of its residents, the progress of implementing those recommendations, as well as the annual net spending by public payors on prescription pharmaceutical products as a measure of the efficacy of implementation of those recommendations to date, to the standing committees of the general court with jurisdiction over health coverage and insurance matters and to the governor.(j) The report in (i) above shall also contain the following information about prescription drugs, both brand name and generic: (1) The 25 most frequently prescribed drugs in the state as reflected in the New Hampshire All Payor Claim database or such like database then in use in New Hampshire at that time;(2) The 25 costliest drugs as determined by the total amount spent on those drugs in the state; and(3) The 25 drugs with the highest year-over-year cost increases as determined by the total amount spent on those drugs in the state.N.H. Code Admin. R. Pdab 301.01
Derived from Number 2, Filed January 12, 2023, Proposed by #13500-B, Effective 12/1/2022, Expires 12/2/2032.