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NH committee hears bill to limit midyear prescription-formulary changes
Summary
The Senate Health & Human Services Committee heard testimony on SB 544, which would bar insurers from making significant formulary changes midplan year; sponsors cited harms to patients and continuity of care, while insurers warned of higher premiums and operational challenges.
Sen. Donovan Fenton told the Senate Health & Human Services Committee that Senate Bill 544 is intended to protect patients and families from sudden midyear changes to prescription drug formularies that can leave people without medicines they rely on. “If an insurer sells a plan with a certain formulary, they should not be able to fundamentally change that formulary midyear in ways that can harm patients,” Fenton said in opening testimony.
The bill would allow insurers to make significant formulary shifts only at plan renewal, when consumers can shop for new coverage. Fenton said the change aims to preserve continuity of care after families reported abrupt removals of needed drugs. John Stewart, a constituent who testified in support, described a relative brought to tears after receiving notice that an effective medication would no longer be covered and the family’s subsequent scramble to find alternatives.
Advocates said the measure matters especially for people with chronic mental-health conditions and other illnesses that require careful medication trials. Holly Stevens, director of public policy at NAMI New Hampshire, told the committee that finding the right psychiatric medication can take six months to a year and that midyear formulary changes can force repeat, destabilizing medication trials.
Insurers, including Anthem, Cigna and Harvard Pilgrim, opposed the bill as written. Sabrina Dunlap of Anthem argued the bill would “significantly limit our ability to manage our formulary and make timely changes for the benefit of our members,” citing safety, cost-management reasons and industry practices such as promoting biosimilars. Anthem’s analysis estimated the measure could raise premiums by roughly $10 per member per month for fully insured members, a figure the company said would translate into millions in added annual costs.
Carriers and industry witnesses also told the committee that many commercial plans begin coverage on different dates throughout the year, which would require insurers to maintain multiple, overlapping formularies if changes were restricted to plan renewals. That operational complexity, carriers said, would be a major driver of higher premiums.
Committee members pressed both sides on details: how prior authorization and exception processes currently work, whether notice and grandfathering provisions protect patients, and how savings from formulary changes are — or are not — passed through to consumers. Sponsors acknowledged the fiscal concerns and said the finance committee would review a fiscal note; Fenton and supporters asked for time to refine language (for example, clarifying whether the bill should prohibit only removals rather than any “modification”).
The hearing record includes testimony from patients, behavioral-health advocates and insurers and does not include a committee vote on SB 544. The committee closed the SB 544 hearing after hearing all scheduled testimony; members signaled they would continue working on the language and fiscal implications before taking action.
