NH SB478

Prohibits pharmacy benefit managers (PBMs) from deriving income from any source other than flat management fees, banning spread pricing and requiring all manufacturer rebates to be passed through to insurers or health plans to reduce premiums or patient costs

Bans retroactive fees, recoupments, or "DIR-like" adjustments on clean pharmacy claims after adjudication, except for fraud, waste, or abuse identified within 60 days, and requires PBMs to provide pharmacies timely access to maximum allowable cost lists with electronic appeals resolved within 7 business days

Prohibits discrimination against 340B covered entities by requiring equal reimbursement rates regardless of 340B status and bars mandatory use of mail-order or affiliated pharmacies when network pharmacies offer the same net cost

Mandates formulary placement based on clinical criteria and lowest net cost, requires parity access for biosimilars, caps insulin cost-sharing at $30 per 30-day supply for fully insured plans, and establishes electronic prior authorization with 48-hour urgent and 5-day standard decision timelines

Requires PBMs to file annual confidential reports with the NH Insurance Department on rebates, fees, and retained amounts, with aggregated data published publicly, and establishes a duty of care requiring PBMs to act in the best interests of enrollees, health plans, and providers, effective January 1, 2027