NH Prescription Drug Affordability Board asks for modest budget as members cite $6 million in potential savings

The New Hampshire Prescription Drug Affordability Board asked the House Finance Committee on the morning of the committee’s working session to continue its modest operating support while the board develops recommendations to reduce drug spending. "I'm Kirk Williamson, and I am the executive director of the Prescription Drug Affordability Board," Williamson told the panel as he summarized the board’s mission and budget request.

The governor's recommended operating funding for the board totals $256,579 in fiscal 2026 with a small increase projected in fiscal 2027, Williamson said. He told members the board has identified about $6,000,000 in "potential estimated savings" when benchmarking certain state drug spending against newly public Medicare negotiated prices for an initial set of drugs.

That estimate, and the board’s work to develop recommendations and tools for consumers and plan sponsors, is the basis for the board’s request that the legislature continue funding its single full‑time position and modest program support. "Our budget is highly efficient, totals $256,579 in FY '26," Williamson said. He added later that the board is pursuing a "state‑backed pharmacy savings card that would be no cost to the state" and that Connecticut’s similar program produces an average savings of about $240 per prescription in the example cited.

Why it matters: the board analyzes prescription drug spending for state and local public payers and issues policy recommendations aimed at lowering costs for taxpayers, plan sponsors and patients. Committee members pressed the board for more concrete return‑on‑investment estimates because one bill in the Legislature would repeal the board and another would make technical changes to its statutory authorization.

Details of the board’s work and constraints

Williamson described the board’s core duties: monitoring prescribing and spending trends, identifying concentrated, high‑cost drugs and making recommendations to public payers and the legislature. He stressed limits on the board’s authority: "But we can only make recommendations. I want to be very clear. We don't have enforcement authority," he said.

Williamson told members the $6 million figure comes from comparing estimated net prices the state and local plans are effectively paying to the publicly available Medicare negotiated net prices for an initial set of 10 high‑cost drugs that recently became subject to federal negotiation. "We did an analysis that looked at estimated what our current rebate capture is for just 10 drugs that were negotiated by Medicare... we identified $6,000,000 just on those first 10 drugs," Williamson said.

Board governance and data approach

The board has an advisory council containing representatives from unions, the Department of Administrative Services (DAS), Department of Health and Human Services (HHS), Medicaid, the Department of Corrections, the community college system and the university system, Williamson said. He said the board relies on existing state data holders and the all‑payer claims database rather than accumulating a standalone data store.

Nathan White, chief financial officer at the Department of Health and Human Services, clarified the board’s fiscal accounting and the status of a dedicated non‑lapsing fund created in statute. "It's under RSA 126‑BB‑8," White said, and he explained the statutory non‑lapsing fund may be used to pay administrative, technical and legal support; but because there are no dollars currently in that dedicated fund, the board’s operating line appears in the governor’s operating budget as a general fund accounting unit (class code 6273). White said the standard process would apply if donations or other revenue were received: funds would be accepted through the fiscal committee and Governor and Council and then added to the account by DAS.

Committee members pressed several operational items

- Due process and fiscal note: Members discussed a fiscal note of roughly $100,000 a year tied to establishing a due‑process mechanism for private‑sector data queries. Williamson said the board assumed additional personnel would be required to operate such a process, but he also said the board could likely manage that with an MOU and by leveraging the insurance department’s existing infrastructure, reducing or eliminating the fiscal note if agencies cooperate.

- Contracting and program support: The governor’s budget includes $65,000 in contract funding for program services. Williamson said some potential vendors told the board that amount may be too low to attract bids. He also noted that every board contract must be approved by the fiscal committee in addition to Governor and Council, which can slow procurement.

- Donations and dedicated fund: Chairman Edwards and Williamson sought clarification about whether the statute's dedicated fund has been established in practice. White said the statutory authority for the account exists but that no donations have been received and no separate accounting activity appears because there is currently no revenue in that fund.

Proposals and outreach

Williamson described a proposed state‑backed pharmacy discount card to be administered by ArrayRx; he said the model used in Connecticut does not sell consumer data and does not charge pharmacies per transaction. The board is continuing stakeholder outreach and has begun formalizing recommendations that could include promoting biosimilar uptake, strengthening PBM contracting transparency and pursuing collaborative strategies for state and local plan sponsors.

Legislative context and requests from lawmakers

Committee members repeatedly asked for a clear business case showing how continued funding would produce a measurable return. Representative Edwards said the investments made so far should be treated as sunk costs and asked the board for an "Excel sheet" style ROI projection showing projected savings over the two‑year budget period. Williamson and Gary Merchant, chair of the Prescription Drug Affordability Board, both urged continuation of funding while the board finalizes recommendations. "We're at the cusp of making some really good recommendations," Merchant said.

Several members flagged near‑term legislative decisions. Committee members noted the House was scheduled to vote on HB 570 the following day; Williamson said a committee amendment to HB 570 would, if adopted, repeal the board. He and others said that vote will determine whether the board continues to operate while it completes its current work.

Public‑facing materials and next steps

Williamson told the committee the board has published materials, meets openly, and will follow up with more documentation on the $6 million estimate and the slide deck details requested by members. He said the board can send formal recommendation letters to state plan purchasers and that he would work with committee members on additional analysis requested, including detailed ROI projections, counts of people estimated to benefit from a discount card, and a clearer description of which payers would have access to Medicare negotiated prices under various proposed approaches.

No formal committee votes were recorded during the working session.