NH SB547

Establishes fiduciary duty for pharmacy benefit managers (PBMs) to their health carrier clients, requiring them to act with care, skill, prudence, and diligence while disclosing any conflicts of interest in writing

Prohibits PBMs from retaining any portion of "spread pricing" (the difference between what PBMs charge health carriers and what they pay pharmacies for drugs)

Bans health carriers and PBMs from using financial incentives like varied copayments or deductibles to steer patients toward mail order or retail pharmacies affiliated with the PBM

Requires quarterly reporting by PBMs to the Insurance Commissioner on rebates collected, administrative fees received, and aggregate spending on pharmaceuticals, with the Commissioner publishing annual transparency reports

Expands the definition of "rebate" to include all manufacturer discounts and price concessions, including value-based and performance-based contracts, and takes effect October 1, 2026