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Bill

SB 247

prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.

2026 Regular Session Introduced by Kevin Avard and 4 co-sponsors

Prohibits PBMs from excluding pharmacies from networks when their reimbursement for a prescription is below the pharmacy’s acquisition cost, preserving pharmacist participation and

Refer for Interim Study: MA VV 01/07/2026 HJ 1 P. 46
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Bill Summary · SB 247

Summary of SB 247 (2026, New Hampshire)

Overview

SB 247 seeks to prohibit network exclusions by pharmacy benefit managers (PBMs) when pharmacies refuse to dispense a prescription if the PBM’s reimbursement to the pharmacy is below the pharmacy’s acquisition cost. In other words, it targets PBM practices that may cut off participation or network access to pharmacies when their reimbursement offers do not cover the pharmacy’s cost to acquire the drug.

  • Jurisdiction: New Hampshire
  • Session: 2026
  • Primary focus: Pharmacy networks, PBM reimbursement practices, and access to dispensing for patients

Purpose and Intent

  • To prevent PBMs from excluding pharmacies from networks or otherwise penalizing them when the reimbursement offered for a prescription is below the pharmacy’s cost to acquire the drug.
  • To ensure pharmacies can dispense prescriptions without being penalized for low PBM reimbursements that do not cover acquisition costs.
  • To promote continued pharmacy participation in networks, patient access to medications, and potentially more predictable patient costs.

Key Provisions (as inferred from the bill’s title and history)

  • Prohibition on network exclusion: PBMs may not exclude a pharmacy from a network solely because the PBM’s reimbursement for a dispensed prescription is less than the pharmacy’s acquisition cost.
  • Financial protection for pharmacies: Creates a standard or requirement aimed at ensuring pharmacies are not forced to participate in networks under economically unsound terms that would cause financial losses on each dispensed prescription.
  • Possible consumer access safeguards: By preventing network exclusions, the bill aims to preserve patient access to a broad network of pharmacies, including independent and community pharmacies.

Note: The detailed statutory language would specify the exact prohibitions, definitions (e.g., what constitutes “acquisition cost,” “reimbursement,” and “network exclusion”), and any exceptions, remedies, or enforcement mechanisms. The summary focuses on the substantive intent indicated by the title and the bill’s trajectory.

Affected Parties

  • Pharmacies: Particularly independent and community pharmacies that frequently face reimbursement below cost.
  • PBMs: Insurers and PBM entities operating pharmacy networks, who negotiate reimbursements with pharmacies.
  • Patients: End users who rely on access to pharmacies within PBM networks for prescription medications.
  • Employers and health plans: Indirectly affected as the terms governing payer–pharmacy negotiations can influence formulary management and out-of-pocket costs.
  • State regulators: Possible enforcement and oversight authorities to implement and enforce the prohibition.

Procedural and Timeline Aspects

  • Early-stage process: The bill has undergone multiple committee actions, hearings, and amendments, with activity indicating progression toward interim study before potential full consideration.
    • Most recent activity shows continued committee referrals and interim study discussions (as of 2026).
    • Historical action highlights include: introduction in 2025, public hearings in 2025, and committee votes indicating a favorable signal toward study and potential advancement.
  • Interim study: The bill was referred for interim study, suggesting a period of review, data gathering, and stakeholder input before final legislative decisions.
  • Next steps (typical for NH process): If the interim study yields favorable findings, the bill could be moved toward a formal floor vote, potential amendments, and then passage or rejection by the full Legislature.

Potential Impact

  • Pharmacies could achieve greater pricing security in PBM contracts, reducing the risk of exclusion from networks due to below-cost reimbursements.
  • PBMs might need to adjust reimbursement practices to ensure they do not drive network withdrawals or limit pharmacy participation.
  • Patients could experience more robust access to in-network pharmacies, contributing to more consistent medication availability and potential saving opportunities.
  • The policy could influence ongoing dynamics between PBMs, pharmacists, and health plans regarding reimbursement methodologies and network adequacy.

If you’d like, I can tailor this summary to include assumed definitions (e.g., acquisition cost, reimbursement) once the bill’s full text is available, or add a brief comparison to similar statutes in other states.

Compiled from official sources — confirm details with the bill’s official record.

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