Committee Weighs Broad PBM and Pharmacy Pricing Bill; Industry and Regulators Clash Over Fiduciary, Reporting and Steering Provisions

Senate Bill 665, a multi‑part rewrite of New Hampshire’s PBM and pharmacy‑pricing statutes, prompted detailed testimony from the Insurance Department, PBM trade groups, insurers and providers.

Michelle Heaton of the Insurance Department summarized the governor’s and department’s effort to harmonize licensing and oversight, adding that the draft clarifies that PBM acts done under contract are considered acts of the carrier. She said the bill updates data‑reporting and enforcement authorities but noted some additions — notably fiduciary‑duty language, semiannual reporting of rebate flows and anti‑steering provisions — were likely to provoke litigation or operational complexity.

PBM representatives focused on three main concerns: (1) fiduciary‑duty language that could mischaracterize contractual relationships and invite litigation, (2) a move from annual to semiannual reporting that they said would add administrative burden without improving transparency, and (3) anti‑steering language limiting incentives to direct people to lower‑cost pharmacies, which PBMs said could unintentionally block legitimate cost‑saving arrangements.

Insurers emphasized the need to preserve flexibility for tailored utilization management; consumer advocates and some lawmakers countered that clearer disclosure of spread pricing and rebate flows is needed to ensure patients and plan sponsors benefit from discounts. Several industry witnesses urged the committee to focus amendments on a narrow set of items rather than a wholesale statutory rewrite, and to avoid provisions likely to trigger preemption tests or lengthy litigation.

Committee members suggested targeted fixes and signaled willingness to negotiate on fiduciary wording and reporting cadence; several stakeholders urged more time for technical drafting before a vote.