Committee Summary for Senate Health and Human Services (03/12/2025)

Bill/Time	Type	Title	Sponsor
SB252 00:04:05.360 - 8:47:46 AM	Public Hearing	relative to criteria for providing certain medical care through telemedicine.	Prentiss, Suzanne(D)[F]2024
SB250 2024-1453h 00:35:02.440 - 9:18:43 AM	Public Hearing	relative to pharmacist administration of long-acting injectable drugs.	Rochefort, David(R)
SB254 00:43:50.119 - 9:27:31 AM	Public Hearing	relative to controlled substance inventories.	Rochefort, David(R)
SB247 00:47:14.960 - 9:30:55 AM	Public Hearing	prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.	Rochefort, David(R)
SB250 01:07:51.240 - 9:51:32 AM	Executive Session	relative to pharmacist administration of long-acting injectable drugs.	Rochefort, David(R)

SB252: Senator Suptren, District 5, representing Upper Valley, parts of Grafton County, Sullivan County, and New London Support00:04:05.360 - 8:47:46 AM; Senator Suptren introduced Senate Bill 252, aimed at enhancing access to healthcare through telemedicine for incarcerated individuals. The bill seeks to establish a healthcare relationship during incarceration to ensure continuity of care upon release, which could reduce emergency department visits and overall healthcare costs. The senator mentioned potential amendments, including the involvement of nurse practitioners and physician assistants, and the exclusion of eye care from telemedicine due to the need for physical exams. The senator also highlighted the work of the Telehealth Commission and the importance of aligning state laws with federal regulations regarding telemedicine.
SB252: Dr. Jonathan Ballard, Chief Medical Officer, New Hampshire Department of Health and Human Services Information Only00:09:44.800 - 8:53:25 AM; Dr. Ballard provided information on the findings of the Telehealth Commission, which he chaired. He discussed the increased use of telehealth during the COVID-19 pandemic and the need to align New Hampshire's stricter laws with federal regulations, particularly regarding the prescription of controlled medications via telehealth. The commission's final recommendation was to amend state statutes to allow for such prescriptions without an in-person visit, supported by data showing the safety and effectiveness of telehealth for various conditions.
SB252: Senator Information Only00:14:22.040 - 8:58:03 AM; The Senator expressed concerns about the telemedicine provision in the bill, specifically regarding the prescription of opioids without an initial in-person or telemedicine consultation to establish a physician-patient relationship. They questioned the necessity of a one-on-one interaction before prescribing opioids, even if it could be done via telemedicine.
SB252: Senator Berel Information Only00:15:33.920 - 8:59:14 AM; Senator Berel responded to the previous question, explaining that on the nonopioid side, telemedicine has been effective for engaging patients, particularly in cognitive-based services where physical exams are not necessary. For opioids, they mentioned that hospice providers in rural areas have difficulty prescribing necessary medications due to the current statute's requirements. They clarified that prescribing opioids through telemedicine without following standards of care would be reportable to the Board of Medicine.
SB252: Senator Information Only00:16:31.959 - 9:00:12 AM; The Senator sought clarification on whether the scenario described typically occurs in hospice settings. The response confirmed that a provider from the Telehealth Commission had discussed a case involving an elderly, homebound patient on small amounts of opioids, highlighting the need for flexibility in prescribing due to the patient's inability to travel.
SB252: Senator Information Only00:17:38.080 - 9:01:19 AM; The Senator reiterated the importance of a one-on-one relationship, even if via telemedicine, before prescribing opioids. They suggested that if the goal was to eliminate opioid prescribing through telehealth without a follow-up in-person visit, the language in the bill could be adjusted to focus solely on nonopioid controlled medications.
SB252: Senator Information Only00:18:49.679 - 9:02:30 AM; The Senator asked for a definition of a 'small amount' of opioids, to which it was explained that in the scenario discussed, it was a low-level prescription for a controlled medication, both in dose and quantity.
SB252: Senator Information Only00:20:00.440 - 9:03:41 AM; The Senator discussed the Ryan Haight Act of 2008 and its temporary relaxations during the 2020 pandemic, which allowed for telemedicine flexibility in prescribing controlled medications. They noted that New Hampshire's statutes are currently stricter than federal guidelines, which are set to remain flexible until December 2025. They also mentioned the importance of telemedicine for incarcerated individuals to establish relationships with providers pre-release to reduce recidivism.
SB252: Senator Information Only00:24:36.880 - 9:08:17 AM; The Senator asked if the restrictive rules disproportionately affect hospice patients, to which it was clarified that the law applies to all providers, but enacting the bill as written would allow hospice patients to receive controlled medications via telemedicine.
SB252: Jim Mahan, Dun Group, representing New Hampshire Nurse Practitioners Support00:25:31.880 - 9:09:12 AM; Jim Mahan supported the bill, highlighting its timeliness and the need for amendments to include nurse practitioners under RSA 326. He emphasized the importance of aligning state statutes with federal guidelines to avoid confusion for providers and patients. He also cautioned against limiting the bill to non-opioids without consulting substance use disorder providers, especially in rural areas, and mentioned the need to ensure physician assistants are adequately covered under the bill.
SB252: Ain Thalson, Council of State Government Justice Center Support00:30:19.279 - 9:14:00 AM; Ain Thalson supported SB 252, emphasizing its importance for improving healthcare access for individuals cycling between behavioral health and criminal justice systems. They highlighted the reliance on Medicaid for substance use disorder and mental health treatment among those released from prison, and the challenges of housing instability and access to consistent medical care. They stressed the bill's role in facilitating pre-release case planning and post-release medical continuity, reducing reliance on emergency services, and improving health outcomes.
SB250 2024-1453h: David Roser, Senator, representing Senate District 1 (Coos County and northern third of Grafton County) Support00:35:02.440 - 9:18:43 AM; Senator David Roser introduced SB 250, which aims to clarify and expand the role of pharmacists in administering controlled substances. He explained that the bill addresses ambiguity in the law by allowing pharmacists to administer controlled substances, which could improve compliance and outcomes for patients, particularly those receiving medication-assisted treatment for substance use disorders. He highlighted the potential benefits for rural communities and mentioned an amendment needed to ensure pharmacists are reimbursed for administering these drugs.
SB250 2024-1453h: Michelle Heat, Director of Life and Health, New Hampshire Insurance Department Support00:42:06.760 - 9:25:47 AM; Michelle Heat supported SB 250 and mentioned that the only concern was the wording in lines 13 through 15, which needed to be revised to ensure pharmacists are reimbursed for administering controlled substances. She confirmed that an amendment had been worked out with Senator Roser to address this issue.
SB254: David Roser, Senator, representing Senate District 1 (Coos County and northern third of Grafton County) Support00:43:50.119 - 9:27:31 AM; Senator David Roser introduced SB 254 as a technical correction to align New Hampshire's controlled substance inventory laws with federal law. He explained that a previous change to align with federal law missed a part of the old law, causing confusion and burden for regulators and pharmacies. The bill aims to correct this by removing the requirement for inventories to be done every odd-numbered year.
SB254: Caitlyn Kamo, resident of New Hampshire, practicing pharmacist, New Hampshire Pharmacist Association Support00:46:04.400 - 9:29:45 AM; Caitlyn Kamo testified in support of Senate Bill 254, describing it as a technical change that provides more freedom for pharmacies to conduct their business. She emphasized that the bill aligns with federal statutes and practices in surrounding states, and it is not controversial but rather offers more flexibility for pharmacies to perform their jobs effectively.
SB247: David Roser, Senator, representing Senate District 1 (Coos County and northern third of Grafton County) Support00:47:14.960 - 9:30:55 AM; Senator David Roser introduced Senate Bill 247, which aims to protect pharmacies from being excluded from networks if they refuse to dispense prescriptions where the reimbursement is below their acquisition cost. He explained the role of pharmacy benefit managers (PBMs) and pharmacy service administration organizations (PSAOs) in the drug dispensing process, highlighting the challenges pharmacies face with underwater reimbursements. He mentioned ongoing discussions with the Department of Insurance to amend the bill to place it in the correct section of law and to include consumer protections against PSAOs.
SB247: Michelle Heaton, Director of Life and Health for the New Hampshire Insurance Department Information Only00:52:52.599 - 9:36:33 AM; Michelle Heaton discussed the Department of Insurance's concerns regarding the placement of provisions in Senate Bill 247. She mentioned working with Senator Rochford on an amendment to address these concerns and ensure the bill aligns with the intended vision. She indicated that amendments would be presented the following week.
SB247: Glenn Peralt, Pharmacist and Owner of Colonial Pharmacy in New London, New Hampshire Support00:53:41.559 - 9:37:22 AM; Glenn Peralt supported Senate Bill 247, sharing his experiences with significant underwater reimbursements on brand name medications. He described his approach of not stocking brand name drugs unless adequately reimbursed and the impact on patients, often requiring them to switch to less preferred generic medications. He discussed his interactions with PBMs, including CVS Caremark, and the challenges with contract negotiations and redlining. Peralt also touched on the role of PSAOs and the potential benefits of eliminating PBMs and PSAOs to allow patients to make their own healthcare decisions using an EBT or HSA card system. He emphasized the need for transparency in contracts between PSAOs and PBMs.
SB247: Unnamed Speaker Information Only01:04:44.480 - 9:48:25 AM; The speaker discussed the concept of Maximum Allowable Cost (MAC) and how it varies across 148 different MAC lists, which are assigned based on the size of the insurance company's population. They highlighted the challenge of pharmacies having to manage these different lists, as they can only buy drugs at one price, regardless of the insurance company's size.
SB247: Unnamed Speaker Information Only01:05:52.880 - 9:49:33 AM; The speaker responded to a question about the number of PSAOs (Pharmacy Services Administrative Organizations), stating there are six known PSAOs, most of which are affiliated with wholesalers, except for two independent ones. They explained that a pharmacy's affiliation with a wholesaler limits their ability to contract with other PSAOs.
SB247: Robert Barry, General Counsel, Division of Medicaid Information Only01:06:49.039 - 9:50:30 AM; Robert Barry addressed concerns raised by Medicaid about potential conflicts with federal guidelines if the bill were to pass. He also mentioned a potential conflict with another bill, SP19, related to generics, and confirmed that an amendment would be necessary to address these issues.
SB250: Committee Members Vote01:07:51.240 - 9:51:32 AM; The committee moved into an executive session to discuss SB250. A motion was made and seconded to pass SB250 with a committee amendment. The amendment specified that pharmacists administering drugs should be reimbursed for administration services in addition to the drug itself. The amendment and the bill as amended were passed with no opposition.

Rochefort, David(Chairman)(R)	Avard, Kevin(V Chairman)(R)[C+]2024	Birdsell, Regina(R)[C+]2024
Prentiss, Suzanne(D)[F]2024	Long, Pat(D)