Committee Summary for Senate Health and Human Services (01/21/2026)

Bill/Time	Type	Title	Sponsor
SB408 00:02:17.360 - 8:01:34 AM	Public Hearing	relative to health insurance coverage for prosthetics.	Gannon, Bill(R)[B-]2025
SB408 01:03:25.280 - 9:02:42 AM	Executive Session	relative to health insurance coverage for prosthetics.	Gannon, Bill(R)[B-]2025
SB454 01:07:26.640 - 9:06:43 AM	Public Hearing	requiring the department of health and human services to update existing relevant public health outreach programs by incorporating information to aid public understanding and awareness of Alzheimer's disease and other dementias.	Avard, Kevin(R)[B]2025
SB454 0173 -	Executive Session	requiring the department of health and human services to update existing relevant public health outreach programs by incorporating information to aid public understanding and awareness of Alzheimer's disease and other dementias.	Avard, Kevin(R)[B]2025
SB441 01:37:30.880 - 9:36:47 AM	Public Hearing	requiring a municipality that intends to transport a person needing substance use disorder treatment and other support services to have a memorandum of understanding with the receiving municipality prior to transport.	Sullivan, Victoria(R)[A-]2025
SB608 2026-0145s -	Executive Session	relative to family caregiver support in certain programs and child care support for kinship caregivers.	Watters, David(D)[D-]2025
SB506 04:01:57.040 - 12:01:14 PM	Public Hearing	relative to community engagement and work requirements under the state Medicaid program.	Pearl, Howard (R)[B]2025
SB476 04:22:12.000 - 12:21:29 PM	Public Hearing	relative to consumer health care cost transparency.	McGough, Tim(R)[B+]2025
SB477 04:52:00.000 - 12:51:17 PM	Public Hearing	relative to increasing transparency in the 340B Drug Pricing Program.	McGough, Tim(R)[B+]2025
SB478 2026135s 05:40:22.958 - 1:39:39 PM	Public Hearing	relative to strengthening prescription drug affordability and pharmacy benefits manager accountability.	McGough, Tim(R)[B+]2025

SB408: Senator Ganon Support00:02:17.360 - 8:01:34 AM; Senator Ganon shares his personal experience as an amputee, explaining how his current prosthetic leg is functional for daily activities but does not support jogging or extended walking, limiting his exercise and overall health. He discusses a young woman from Hanover who excels in sports like rock climbing and archery with activity-specific prosthetics, but coverage stops at age 18. He emphasizes that the bill would allow one activity-specific prosthetic every five years for adults, improving quality of life, promoting physical activity, and reducing long-term healthcare costs from conditions like diabetes and heart disease. He notes about 50 people per year would benefit, with initial higher demand, and that insurance companies are open to it. The bill passed the Senate unanimously last year but was cut in the House budget.
SB408: Senator Supranos, District 5 Support00:08:52.560 - 8:08:09 AM; Senator Supranos builds on Senator Ganon's points, noting the bill extends coverage for activity-specific prosthetics to adults, previously passed for children. She highlights that sedentary lifestyles due to limb loss lead to costly chronic conditions like diabetes, with lifetime costs of $250,000-$500,000 per person. The bill covers one device every five years for medically necessary activity, excluding the state health plan to avoid general fund costs. New Hampshire has 19,800 adults with limb loss, with 8,900 eligible; utilization is estimated at 10-30%. She argues the upfront cost of $27,000 per device is offset by savings from better physical and mental health, increased workforce participation, and reduced secondary complications like falls and infections. The bill aligns with value-based care and could save money long-term.
SB408: Trey Sumerielli, Four Motion Clinic, Concord Support00:17:16.559 - 8:16:33 AM; Trey Sumerielli, a certified prosthetist at Four Motion Clinic in Concord, supports SB 408, explaining his passion for mobility as essential for full living. He notes that while insurance covers recovery for able-bodied people (e.g., ACL surgery and braces), it does not for amputees needing activity-specific prosthetics. The bill extends children's coverage to adults, benefiting patients like Hudson who seek active lives. Most amputations stem from diabetes, limiting basic mobility; activity prosthetics prevent costly secondary conditions like arthritis and depression. He urges support for long-term health and independence, offering clinic visits for more insight.
SB408: Hudson Hammer, New Hampshire resident Support00:22:02.880 - 8:21:19 AM; Hudson Hammer, a recent below-knee amputee from a May 2025 motorcycle accident, describes the devastation of losing his leg and initial fears about his future work and activity. Videos of Paralympians inspired hope, but his everyday prosthetic only allows walking and working, not running or jumping, constantly reminding him of limitations. He argues activity-specific prosthetics are essential for restoration, not luxury, enabling full physical and mental health, community engagement, and preventing complications. Without insurance coverage, they are inaccessible; the bill provides a fair chance to rebuild life defined by possibility.
SB408: DJ Benton Court, NH Insurance Department Commissioner Support00:25:18.080 - 8:24:35 AM; Commissioner Benton Court supports SB 408 without reservations, despite general caution on mandates. The bill is well-crafted for the large group market, avoiding federal issues, with cost controls like one device every five years to prevent abuse. An updated mandate review identifies 8,900 eligible adults, with 890-2,600 likely users—small numbers but life-changing. Policy benefits outweigh costs, promoting health savings. He cautions against excessive mandates to avoid premium pressures but praises this narrowly tailored bill.
SB408: Jason Walla, from Bow, New Hampshire Support00:31:16.880 - 8:30:33 AM; Jason Walla, a certified prosthetist with clinics in Manchester, Concord, and Lebanon, New Hampshire, and an above-knee amputee himself, shares his personal experience. He explains how receiving a sport-specific prosthesis after his motorcycle accident 37 years ago transformed his life, allowing him to pursue cycling, mountain biking, and skiing, which improved his mental health and activity level. He highlights the limitations of everyday prostheses for sports, increasing injury risk, and notes that foundations provide only one-time grants. Walla discusses generational health benefits, as his active lifestyle influenced his children's health. He urges support for SB 408 to join 11 other states in investing in the health of individuals with limb loss, emphasizing reduced risks of obesity, diabetes, and heart disease through activity.
SB408: Dana Clark, Veteran Support00:38:47.440 - 8:38:04 AM; Dana Clark recounts her 2021 motorcycle accident leading to a below-knee amputation on her right leg, feeling imprisoned in a wheelchair and questioning her quality of life. As a veteran, she accessed a facility like ForMotion through the VA, which provided an everyday prosthetic allowing her to perform daily chores like laundry, cooking, yard work, and grocery shopping independently. She also received a running blade prosthetic, enabling her to run, hunt in the woods, and tap maple trees, maintaining her physical and mental health. Clark stresses that supporting SB 408 would help less fortunate individuals access multiple prostheses, getting them out of wheelchairs and back to active lives, changing lives for the better.
SB408: Samantha Torres, Hanger Clinic in Portsmouth, resident of EP, New Hampshire Support00:42:03.119 - 8:41:20 AM; Samantha Torres, working at Hanger Clinic in Portsmouth and a resident of EP (likely Epping), New Hampshire, advocates for SB 408 to ensure all eligible amputees receive activity-specific prostheses. She explains the profound physical and mental health benefits of activity, noting patients' fears of sedentary lifestyles post-amputation leading to costly health issues like hospitalizations and inability to stay in their homes. Torres shares examples: challenging an insurance denial for a safer microprocessor knee for a patient progressing in activities but facing safety issues on uneven terrain or ice; and a VA-provided quadruple amputee who walks up to six miles daily with activity-specific prostheses, underscoring mental and physical well-being. She calls for the bill as a lifeline for patients with limb loss.
SB408: Keith Adam Support00:45:23.520 - 8:44:40 AM; Keith Adam shares his concern for the importance of SB 408 in helping amputees like himself stay active for physical and mental health. Always active in building houses, mountain biking, golfing, bow hunting, and snowboarding with family, in 2017 at age 55, a virus attacked his heart, leading to months in Boston hospital on life support and amputation of his lower left leg due to lost circulation. With his everyday prosthetic, he managed most activities but struggled with snowboarding, his biggest passion, leading to depression and nearly giving up. His prosthetist, Jason Walla, informed him of sport-specific prosthetics for snowboarding, but they are not covered by insurance, highlighting the need for the bill.
SB408: Unnamed Speaker Support00:47:42.960 - 8:46:59 AM; The speaker shares a personal story of searching for funding for a prosthetic leg for snowboarding after an amputation. They found a grant from Spalding Rehab for a $13,000 sport-specific leg, which dramatically improved their life, allowing them to snowboard weekly and spend time with grandkids. They emphasize the psychological benefits of staying active and urge passage of SB 408 to ensure everyone can access needed prosthetics, preventing long-term health issues like obesity, diabetes, and depression.
SB408: Giovana Shamry, Hanover, NH Support00:49:18.720 - 8:48:35 AM; Giovana, a lifelong New Hampshire resident and high school student in Hanover, was born missing her right hand below the elbow due to amniotic band syndrome. She received her first basic prosthetic at 6 months from Shriner's Children's Hospital in Springfield, MA, and has gone through nearly a dozen devices with various attachments to adapt to daily tasks in a world designed for two-handed people. She describes her active life in New Hampshire, participating in sports like softball, mountain biking, swimming, soccer, rock climbing, hiking, skiing, and pond hockey, all enabled by prosthetics. She also plays violin and piano with adaptive devices. As she grows older, she worries about losing Shriner's coverage and the costs of replacing prosthetics, potentially forcing her to give up beloved activities that define her and her love for the state. She passionately asks for support of SB 408 to secure a brighter future.
SB408: Maggie Bomber, Hanger Clinic Support00:54:14.160 - 8:53:31 AM; Maggie, in a national role at Hanger Clinic (a major prosthetic provider with facilities in New Hampshire) and legislative lead for the So Everybody Can Move National team, shares her experience as an arm amputee from a 2012 trauma. She demonstrates her daily silicone prosthetic and a separate activity-specific one for yoga, weightlifting, and skiing. She addresses misconceptions about prosthetics, arguing that one device isn't enough for full function, comparing it to insurance covering ACL surgery for restoration. She highlights the national movement, noting New Hampshire's prior SB 177 for kids and 28 bills this session. She shares a positive story about Aiden Collier's transformation after getting a device and her own recovery through activities she loves, which she accesses via her employer's benefits—not available to all. She references past NH laws like the 2003 OMP parity act and SB 77, notes low costs (1-5 cents per member/month premium increase, ~$275,000 state cost), and contrasts with out-of-pocket expenses of $80,000-$150,000, which can lead to higher healthcare costs without proper devices. She requests support for SB 408.
SB408: Peter Bragden, Harvard Pilgrim Healthcare Information Only00:59:45.359 - 8:59:02 AM; Peter, a former state legislator and senior policy adviser for Parity Strategist in Concord, represents Harvard Pilgrim Healthcare. He provides an umbrella statement on coverage mandates, noting eight such bills this year, commending SB 408 for its defined mandate review unlike others. He discusses how NH health insurance rates rose 15% on average for 2026 (up to 35% for some plans), with mandates contributing. Rising premiums may lead employers to drop coverage or shift to high-deductible plans, resulting in uninsured people, delayed care, non-adherence to medications, and a vicious cycle of higher costs. While acknowledging long-term benefits and that this mandate is small, he urges balancing short-term impacts like reduced insurance access. For consistency, he recommends including state employee plans and risk pools in mandates, as they currently don't follow the same rules, making it hard for private insurers to compete.
SB408: Committee Support01:03:25.280 - 9:02:42 AM; The committee moves into executive session on SB 408. A motion to ought to pass is made and seconded. There is no further discussion. The vote is 4-0 in favor on consent. Senator Apprill agrees to take the bill out.
SB454: Senator Kevin Avard, District 12 Support01:07:26.640 - 9:06:43 AM; Senator Avard, as the prime sponsor and chair of the Alzheimer's subcommittee, introduced SB454, emphasizing the crisis of Alzheimer's affecting 10% of New Hampshire's population over 65, the second oldest in the country. He highlighted the need for awareness to support caregivers with 24/7 commitments, providing respite and resources to prevent breakdowns. He noted personal connections and a hospital's underknown relief program. Under subcommittee direction, collaborated with the Alzheimer's Association and DHHS on a low-cost amendment (about $10,000 fiscal note) to integrate Alzheimer's priorities into public health efforts, educate providers, break stigma on early onset, and reduce long-term system strain. Urged support for this high-impact step.
SB454: Wendy Alman, Bureau Chief, Bureau of Adult and Aging Services, DHHS Support01:14:16.880 - 9:13:33 AM; Wendy Alman explained DHHS's role in implementing SB454, which directs incorporation of Alzheimer's and dementia information into existing public health outreach, including early detection tools and Medicare resources for providers. Thanked Senator Avard for collaboration; no fiscal impact anticipated as work can be absorbed. Aligned with NH's Brain Health Project findings on inconsistent early awareness, messaging gaps, underutilized Medicare visits, and late caregiver education. The bill focuses on awareness without expanding services, supporting planning to avoid over-medicalization and reduce stress.
SB454: Jenny Han, Senior Public Policy Manager, Alzheimer's Association Support01:19:40.400 - 9:18:57 AM; Jenny Han expressed strong support for SB454, thanking Senator Avard and DHHS for collaboration on the amendment. Noted over 26,500 NH residents with Alzheimer's (likely undercounted due to stigma), growing impact on families and systems. Built on successful Brain Health campaign (16.6M impressions) to sustain momentum amid advancing treatments and US Pointer study on lifestyle factors reducing risk. Amendment integrates education on early signs, diagnosis, chronic links, lifestyle interventions for public; risk reduction, tools, treatments for providers. Requires biennial reports to subcommittee and pursues funding for CDC's Healthy Brain Initiative. Low-cost, high-impact: early diagnosis saves $63,000/person, reduces $363M Medicaid costs in 2025.
SB454: Olivia Parzek, Bow, NH Support01:25:57.360 - 9:25:14 AM; Olivia Parzek urged support for SB454, drawing from neuroscience background and caregiving for her grandfather who died of Alzheimer's. Highlighted the disease as a public health crisis with emotional, cognitive, financial tolls; stressed early intervention, prevention, education. Created youth programs to address generational knowledge gaps on brain health and dementia signs. Noted 40% of primary care physicians feel unprepared for detection, delaying care. Bill provides tools for residents and providers; aligns with US Pointer on lifestyle interventions reducing decline risk. Personal experience fuels passion to prepare families, positioning NH as leader in awareness and hope.
SB454: Leah Farley, Hopkinton, NH Support01:28:48.400 - 9:28:05 AM; Leah shares her personal journey with mild cognitive impairment due to Alzheimer's, diagnosed in 2023 after three and a half years of symptoms and dismissed concerns. She describes initial signs like word-finding difficulties, memory lapses, and navigation issues while running a counseling practice and nonprofit. Multiple doctors initially attributed symptoms to stress or normal aging, delaying diagnosis until extensive testing confirmed Alzheimer's. The diagnosis allowed her to close her practice, plan her affairs, and adopt lifestyle changes like exercise, the MIND diet, puzzles, sleep, and social activities. She emphasizes the importance of early diagnosis for planning, accessing treatments that slow progression, and lifestyle interventions. SB454 would raise awareness among the public and providers to recognize subtle early signs, reducing fear and self-blame, especially for those under 65.
SB441: Senator Victoria Sullivan, District 18 (Manchester Wards 5-9 and Litchfield) Support01:37:30.880 - 9:36:47 AM; Senator Sullivan introduces SB441FN, requiring municipalities to have a memorandum of understanding (MOU) before transporting homeless or substance-affected individuals to another municipality for services. She highlights Manchester's burden from uncoordinated transports, including from out-of-state, leading to stranded individuals and increased costs. She criticizes state-funded harm reduction programs, distributing drug paraphernalia like pipes, syringes, and warming cups, which she argues encourage use rather than recovery. The bill would give municipalities control over such organizations. She addresses the fiscal note, suggesting removal of DHHS enforcement provisions to avoid needing a full-time employee, leaving agreements between municipalities.
SB441: Chrissy Cantor, Alderman Ward 6, Manchester Support01:52:08.159 - 9:51:25 AM; Alderman Cantor supports SB441FN, emphasizing fairness and accountability for Manchester taxpayers bearing the addiction crisis burden without reimbursement from sending municipalities. She advocates for MOUs to share costs and local control over harm reduction services, criticizing kits that normalize addiction and lead to discarded needles in public spaces, including near children. She cites Public Works picking up over 11,685 needles since July 2021. The bill ensures compassion with accountability, preventing Manchester from being the state's default solution.
SB441: Peter Maher, Chief of Police, Manchester Support02:01:38.639 - 10:00:55 AM; Chief Maher supports SB441FN, describing frequent uncoordinated drop-offs by other agencies, leaving individuals stranded and burdening Manchester's police, EMS, and services. The bill requires coordination via MOUs to confirm availability and responsibility, promoting shared accountability without prohibiting transport. He endorses enforcement for compliance, noting increased calls for service from such practices. Enforcement could involve contacting receiving agencies like shelters and police for verification.
SB441: Jenny O. Higgins, Legislative Liaison, DHHS Division for Behavioral Health Information Only02:16:16.159 - 10:15:33 AM; Higgins provides neutral information on fiscal and operational impacts. The bill as written assigns DHHS rulemaking for MOUs and fines, requiring IT systems and staff for oversight of 300+ municipalities, estimated at significant costs. She notes operational challenges, privacy concerns for behavioral health, and statewide service access. Suggests the intent may differ, and municipalities might handle agreements without DHHS involvement. Effective date of July 1, 2026, is tight for rulemaking.
SB441: Jake Barry, Senior Vice President, New Futures Oppose02:30:04.640 - 10:29:21 AM; Barry opposes aspects of SB441FN, particularly MOUs that could delay treatment access during critical windows, leading to worse outcomes. He praises harm reduction programs for declining overdose rates (half of three years ago) via Narcan and evidence-based services. Local infringement on these could undermine progress, increase overdoses, and reverse gains. Urges considering unintended consequences and working to strengthen the system.
SB441: Jennifer Chisum, Executive Director, New Hampshire Coalition to End Homelessness, Manchester Oppose02:34:02.800 - 10:33:19 AM; Jennifer Chisum opposes SB441FN, expressing concerns about barriers to substance use disorder treatment. She argues that the bill allows municipalities to limit transfers, potentially denying access to clinically appropriate care based on unqualified decisions. As a licensed LICSW with 20 years of experience, she highlights risks of delaying treatment during critical moments of readiness. She also notes administrative burdens on untrained municipal employees assessing addiction symptoms and potential violations of federal confidentiality laws (42 CFR Part 2) in tracking information. During Q&A, she suggests focusing on active treatment seekers rather than drop-offs and shares anecdotal data showing low numbers of out-of-town service users.
SB441: Steve Tower, Managing Attorney, New Hampshire Legal Assistance, Manchester Oppose02:42:36.479 - 10:41:53 AM; Steve Tower opposes the MOU requirement in SB441FN, arguing it disrupts local welfare processes under RSA 165, where towns must relieve and maintain poor residents. He notes the bill doesn't address illegal drop-offs at locations like 7-Elevens, as they aren't for receiving services. Small towns without shelters rely on hubs like Manchester, but the unilateral MOU could prevent compliance, especially with $5,000 fines. He explains residency rules (maintained for 30 days post-assistance) and gaps in enforcement between towns. Tower proposes a statutory fair hearing process for residency disputes via impartial third-party administrators to resolve costs without MOUs for welfare cases. For police drop-offs without welfare involvement, he suggests limited MOUs between departments. During Q&A, he clarifies illegal drop-offs violate duties and could lead to legal action.
SB441: Todd Marsh, President, New Hampshire Local Welfare Administrators Association, Somersworth and Rochester Oppose02:58:08.399 - 10:57:25 AM; Todd Marsh opposes SB441FN, urging inexpedient to legislate due to unintended consequences for a non-existent scale of problem. He notes existing RSA 165 already governs placements without changing residency. Key concerns include fiscal impacts like new HHS positions, $5,000 fines, and shifting costs to municipalities for non-municipal nonprofit programs, creating double payments. He condemns 'drop and drive' practices, stating the association's best practices require confirmed placements. The bill could complicate routine transit assistance, turning simple interactions into complex assessments and MOUs, risking delays in care. Municipal employees aren't clinicians, and bureaucracy could close windows of readiness for treatment or shelter.
SB506: Senator Henry Pearl Support04:01:57.040 - 12:01:14 PM; Senator Henry Pearl introduces SB506 to comply with federal work requirements under the 'big beautiful bill act' by December 1, 2026, or earlier. The bill requires DHHS to submit documentation for community engagement and work requirements via state plan amendment. It suspends prior RSA 126-A:2 provisions during federal requirements. He requests holding the bill, as similar language was adopted in retained SB134 from last year, expected to return with concurrence, making SB506 unnecessary.
SB506: Director Litman, DHHS Support04:05:07.359 - 12:04:24 PM; Director Litman supports SB506 for enabling state plan amendment implementation, avoiding slower 1115 waivers with high administrative costs (seven figures). It ensures timely compliance by December 31, 2026, with system changes, and aligns with federal rules. The bill suspends prior state legislation during federal effect, respecting past efforts.
SB506: Jim Monahan, Dupont Group, representing Community Mental Health Centers Information Only04:07:03.840 - 12:06:20 PM; Jim Monahan provides information on SB506 concerns, agreeing to hold it pending CMS guidelines in March. He highlights uncertainties in exemptions for mental illness treatment, reporting frequency, and privacy. Work requirements may disenroll thousands from Medicaid, increasing uncompensated care costs (currently 15-17 million annually for mental health centers). Providers must care for uninsured regardless, straining finances. He suggests a robust uncompensated care pool and state resources for enrollment assistance, noting the 90/10 federal match in Granite Advantage minimizes state savings but exposes providers. Analysis of impacts forthcoming.
SB506: Nancy Beerman, Rare Disease Advisory Council member, representing herself Information Only04:11:14.720 - 12:10:31 PM; Nancy Beerman, parent of an adult with multiple rare diseases, shares concerns on SB506. Managing rare diseases is a full-time job involving appointments and transportation. She urges provisions for patient education, consumer assistance, continuity of care with notice, options for uninsured, due process for terminations, privacy protections, and transparency via monthly reports. Emphasizes time sensitivity for rare disease patients and caregivers.
SB506: David Trumbull Oppose04:16:10.800 - 12:15:27 PM; David Trumbull opposes SB506, citing Urban Institute findings that more eligible people will be disenrolled due to paperwork than ineligible ones removed. Kaiser data shows 92% of Medicaid recipients already work, study, care give, or are disabled; only 8% are non-compliant. In NH, 13% (24,000) may lose coverage, including children. Arkansas's 2018 program disenrolled 18,000 before court halt. Suggests improvements: sufficient caseworkers, streamlined documentation, outreach, automatic eligibility for chronic conditions, mental health/recovery support, and job training to minimize losses.
SB476: Senator Tim Mcu, representing Merrimack, Amherst, Milford, and Wilton, Senate District 11 Support04:22:12.000 - 12:21:29 PM; Senator Mcu introduced SB476, which builds on New Hampshire's all-payer claims database and HealthCost portal to provide more personalized out-of-pocket cost estimates for consumers. He explained that current data shows median prices but not individual costs based on deductibles and co-pays, leading to variability and surprise bills. The bill connects users to their health plans' existing federally required estimators via secure APIs without new state IT infrastructure. This allows shopping around, benefits those with health savings accounts, and includes uninsured patients for better accountability. He provided examples like mammograms with wide price differences and submitted written testimony on MRIs and colonoscopies.
SB476: Representative Julie Miles, from Merrimack, Hillsborough District 12, co-sponsor and critical care nurse Support04:27:48.960 - 12:27:05 PM; As a co-sponsor and experienced nurse, Rep. Miles emphasized the need for upfront price visibility to balance care and cost. She highlighted that SB476 turns the HealthCost website into a single front door connecting patients to personalized pre-service estimates using existing federal tools. This helps families see costs for MRIs, allows HR directors to compare options, and provides consistent data for actuarial models and stop-loss insurance. Transparency prevents care delays, rewards quality, stabilizes premiums, and honors the Department of Insurance's work, ultimately improving access, affordability, and outcomes.
SB476: Sam Burgess, Healthcare Policy Director at New Futures Support04:31:26.880 - 12:30:43 PM; Burgess focused on federal hospital price transparency compliance issues, citing an NIH study showing only 27% compliance among high-revenue hospitals nationally. In New Hampshire, all seven surveyed hospitals (CMC, Concord Hospital, Elliot, Frisbie Memorial, Mary Hitchcock Memorial, Parkland, and Portsmouth Regional) were non-compliant in at least one category per Patient Rights Advocates' November 2024 report. He noted weak CMS enforcement ($300/day max fine) and urged support for SB476 to enhance patient autonomy and transparency, attaching a list of non-compliance reasons.
SB476: Henry Litman, State's Medicaid Director Information Only04:35:35.599 - 12:34:52 PM; Litman expressed departmental support for transparency but suggested working with the sponsor on clarifications: defining 'hospital in good standing' (Section 1, lines 6-8), dashboard details (line 21), API costs in capitation rates (page 3, lines 1-4), effective date flexibility due to OB3 implementation workload, and ensuring qualified staff for compliance assessments. He noted no fiscal note yet but anticipated costs and impacts, emphasizing sensitivity to healthcare needs.
SB476: Ben Bradley, Vice President of State Government Relations, New Hampshire Hospital Association Oppose04:39:45.280 - 12:39:02 PM; Bradley raised concerns about SB476, noting hospitals already comply with federal price transparency and No Surprises Act requirements, issuing thousands of good faith estimates monthly. He criticized Patient Rights Advocates' credibility and argued reporting compliance to DHHS is unnecessary, passing costs to hospitals (page 3). He highlighted the existing NHHealthCost.org platform and requested an amendment to remove hospitals from the bill or recommend inexpedient to legislate to avoid redundant burdens.
SB476: Senator Peter Braggley, representing Harvard Pilgrim Healthcare Oppose04:42:56.958 - 12:42:13 PM; Braggley shared Harvard Pilgrim's concerns about added costs and redundancies. They already provide a cost estimator tool accounting for deductibles. Complying with federal transparency cost over $1 million, plus recent state changes, and this bill would require new interfacing software, increasing premiums without clear benefits. Undefined costs like vendor configuration and API routing raise security and privacy issues. Section 5 duplicates existing self-service tools for shoppable services.
SB476: Michelle, Director of Life and Health, New Hampshire Insurance Department, with Jason, Data Health Economist Information Only04:46:42.160 - 12:45:59 PM; Michelle affirmed departmental support for transparency but noted technical defects in the bill, including potential conflicts with two recently passed held-over bills. They offered to work with sponsors to clean up language. Jason highlighted a 'specificity gap' between self-reported transparency data (hospitals/insurers) and empirical claims data on NHHealthCost, suggesting reconciliation for oversight, compliance, and precise pricing. Michelle added that recent laws and rules require advanced cost estimates for insured/uninsured, offering to collaborate.
SB477: Senator Tim Mcu, Senate District 11, representing Merrimack, Amherst, Milford, and Wilton Support04:52:00.000 - 12:51:17 PM; Senator Mcu introduced SB477, the 340B Sunshine and Savings Act, to increase transparency in the federal 340B drug discount program without altering eligibility or discounts. Created in 1992 as a safety net for providers serving uninsured/low-income patients, program utilization has risen while proportionate uncompensated care spending has declined. Administered by HRSA, it lacks detailed reporting on savings use. The bill requires aggregate reporting on how savings support charity care, rural access, and patient services, ensuring accountability and visibility. It avoids federal preemption, is narrowly tailored, and enhances community confidence and patient outcomes. A local hospital in his district is eager to participate and share usage.
SB477: Representative Julie Miles, District 12, Merrimack Support04:58:52.958 - 12:58:09 PM; Representative Miles shares her background in healthcare, including patient care, medical underwriting, and appeals work where she overturned denials for care. She references Florence Nightingale's emphasis on letting in the sunshine and stresses the importance of transparency in the 340B program, originally created for underinsured and uninsured patients to afford medications. She argues that SB477 ensures savings from discounted drugs are reinvested in charity care, rural services, and patient access, such as mental health, without reducing hospital participation or interfering with care delivery.
SB477: Representative Paulov, representing May Mach Hooks and Donut Support05:01:13.920 - 1:00:30 PM; As a first-year member of the House Health, Human Services, and Elderly Affairs Committee, Representative Paulov supports SB477 for its transparency provisions, including patient notifications and enforcement on page three. He notes that six states, both Republican and Democrat-controlled, have implemented similar measures. With over 200 participating entities in New Hampshire, including a dozen critical access hospitals, oversight is needed to ensure funds are used for charitable services. He mentions federal oversight shifts from HRSA to CMS and the lack of federal reform, making state-level sunshine measures essential.
SB477: Dr. Jason Aziz, Health Economist at the Insurance Department Information Only05:04:28.320 - 1:03:45 PM; Dr. Aziz provides informational testimony supporting healthcare transparency efforts, using the analogy of knowing prices for everyday items like gasoline and groceries versus opaque healthcare bills. He praises SB477 for promoting price transparency in the 340B program, ensuring discounts reach intended low-income populations. During questioning, he discusses challenges with price estimates for complex procedures like hip replacements but notes narrower variability for simpler services. He clarifies the bill's focus on the federal 340B program, explains the shift in federal oversight from HRSA to CMS due to resource constraints, and addresses fiscal impacts, assuming compliance minimizes costs. He emphasizes the inflationary effects on prescription drug costs and the need for state action where federal oversight falls short.
SB477: Henry Litman, State's Medicaid Director Information Only05:14:09.520 - 1:13:26 PM; Henry Litman shares insights on 340B in New Hampshire, noting a 2024 Senate bill that ensured providers' access to support critical access hospitals and federally qualified health centers. Unlike most states, New Hampshire receives 340B rebate revenue for Medicaid patients, funding the program with tens of millions of dollars. He expresses concern that some model legislation aims to limit 340B use, potentially sponsored by pharmacies to protect profits, but clarifies SB477's intent is transparency, not limitation. He suggests technical fixes, such as clarifying the federal reference on page one, line seven, to focus on hospitals; specifying fiscal years for reporting; detailing dashboard requirements and costs on page two; and refining lines 31-35 to align with New Hampshire's Medicaid operations, where providers must opt out of claiming Medicaid rebates. He recommends clarifying the purpose clause to protect 2024 provisions and Medicaid financing, and adjusting the January 1 effective date. During questioning, he agrees that explicit language in the purpose clause could address concerns about impacting Medicaid rebates.
SB477: Ben Bradley, New Hampshire Hospital Association Oppose05:22:57.360 - 1:22:14 PM; Ben Bradley from the New Hampshire Hospital Association opposes SB477FN, arguing it imposes unnecessary and burdensome reporting requirements on 340B participating hospitals, including all 13 critical access hospitals in the state. He explains that the 340B program, established by Congress in 1992, stretches federal resources for providers serving low-income patients and shields them from rising drug prices, which have increased dramatically (e.g., median new drug price from $300,000 in 2023 to $370,000 in 2024). Hospitals face financial pressures, with Medicare reimbursing only 67.7% of costs and nearly a third operating at negative margins in 2024. The bill does not address program benefits or federal accountability but adds state-level administrative burdens, exacerbating regulatory compliance costs (average U.S. community hospital spends $7.6 million annually on federal compliance). Federal oversight by HRSA is robust, including annual recertification, audits, and public reporting. Technical challenges include inability to parse drug reimbursements from bundled payments. He urges recommending Inexpedient to Legislate (ITL).
SB477: Beverly Goodell, Lupus Foundation New England Support05:35:16.000 - 1:34:33 PM; Beverly Goodell from the Lupus Foundation New England supports transparency and accountability measures in SB477 to ensure 340B savings benefit underserved patients with lupus and autoimmune diseases who rely on high-cost medications. She emphasizes that transparency is essential for good governance, highlighting how lack of clear rules has led to uneven oversight, with independent analysis showing patients receive discounted medications in only a small fraction of eligible prescriptions. Strengthening reporting would protect patients, build trust in the program, and keep patients at the center of the policy.
SB478 2026135s: Senator Tim McHugh, District 11 (Merrimack, Amherst, Milford, Wilton) Support05:40:22.958 - 1:39:39 PM; Senator Tim McHugh introduces SB478, the fourth healthcare cost savings act this session, aimed at ending opaque spread pricing, requiring pass-through of PBM compensation, protecting patients, and reinforcing the 340B safety net. The bill strengthens maximum allowable cost transparency, clean claims rules, and provides confidential reporting to NHID for premium savings. It respects free markets, protects trade secrets, and limits enforcement to the Department of Insurance without private rights of action. He notes persistent high pharmacy counter prices and premiums due to spread pricing, citing Ohio's example where PBMs retained over $200 million on generics. The amendment (2026135s) follows NHID guidance for precision, includes targeted definitions, confidential filings, and complies with the Rutledge v. PCMA decision. It delinks PBM pay from list prices, prevents forced steering to mail order, prohibits gag clauses, reinforces 340B non-discrimination, and resets the effective date to January 1. He counters expected arguments against regulation, emphasizing the need for guardrails to ensure savings benefit patients at the counter or in premiums, not margins.
SB478 2026135s: Representative Julie Miles, Merrimack (District 12) Support05:48:10.160 - 1:47:27 PM; Representative Julie Miles, an experienced nurse with healthcare reimbursement and insurance background, supports SB478 for addressing spread pricing and delinking PBM compensation from drug list prices to pay for services rather than inflation. It enhances transparency in maximum allowable cost and clean claims protections to prevent post-claim clawbacks for community pharmacies, protects 340B care from discrimination while allowing audits, and channels savings to patients via point-of-sale options or premiums through confidential NHID reporting. She highlights transparent PBMs as models and stresses the bill's preservation of market flexibility, preferred networks, and predictable costs for employers and municipalities, ensuring families do not choose between essentials and medication.
SB478 2026135s: Michelle Heaton and Dr. Jason Aziz, New Hampshire Insurance Department Information Only05:51:33.040 - 1:50:50 PM; Michelle Heaton, Director of Life and Health at NHID, with Dr. Jason Aziz, Director of Data Analytics, provides information on SB478 without recapping prior testimony. They note multiple PBM bills and willingness to collaborate for consensus, emphasizing precision to avoid upending existing structures, prioritizing transparency over prescriptive pricing, and respecting contractual relationships and jurisdictional limits to minimize litigation and federal preemption risks. They highlight technical defects in the introduced bill conflicting with RSA 402-N (PBM regulation) and 420-J (managed care law), and note the amendment addresses some but requires further work. Dr. Aziz suggests more frequent six-month reporting for better granularity.
SB478 2026135s: Henry Liman, State Medicaid Director Information Only05:58:07.040 - 1:57:24 PM; Henry Liman, State Medicaid Director, informs that Medicaid has already banned spread pricing and clawbacks with MCOs, with rebates benefiting the program. He requests a technical correction to exclude Medicaid from SB478 due to minimal patient pharmaceutical payments, referencing past successful rebate work that saved millions for the state budget.
SB478 2026135s: Cam Leine, Government and Regulatory Affairs Manager at Warner Norcross + Judd, representing PhRMA; Margaret Reynolds, Amherst Information Only06:00:05.600 - 1:59:22 PM; Cam Leine identifies technical issues in SB478: unintended repeal of PBM registration (RSA 402-N:2), contradictory private right of action language (page 8), renumbering issues (addressed in amendment), and duplicative gag clause provisions (already in RSA 420-J:8). He notes the 340B non-discrimination section references a prior bill. Margaret Reynolds is present to discuss policy issues but defers in the transcript.
SB478 2026135s: Cam LePine, Government and Regulatory Affairs Manager at Warner Norcross + Judd, representing PhRMA Information Only06:03:44.160 - 2:03:01 PM; Cam LePine continues testimony, pointing out duplications in SB478 with existing statutes. He notes that Senate Bill 557 already prohibits discrimination in the 340B program, creating duplication. On page four, lines 34-35, prior authorization turnaround times in RSA 420-J:7-b(2) and RSA 420-J:7-b(2-b) are more stringent than those in SB478. On page five, lines 6-8, out-of-pocket insulin costs are already capped by House Bill 1280, codified in RSA 415:6-e, 415:18-f, 420-A:17-a, and 420-B:8-k, making this section duplicative.
SB478 2026135s: Margaret Reynolds, with Express Scripts (a pharmacy benefit manager operating within the Cigna group) Oppose06:05:26.798 - 2:04:43 PM; Margaret Reynolds expresses concerns with SB478, appreciating amendments but highlighting issues. She notes the definition of 'insurer' uses 'health carrier' in statute and references federal law that could include ORSA plans, potentially inviting litigation. The broad definition of pharmacy benefit manager is overly broad and potentially unenforceable. Section four limits PBM compensation, prohibiting spread pricing and delinking rebates, which undermines performance-based compensation and benefits drug manufacturers by allowing price increases without consequences. She suggests amending paragraph three to allow designees to sign certifications. Effective dates should not disrupt 2026 contracts, proposing 1/1/27. For section five, suggests cross-references to pharmacy audit statutes, aligning timelines, and defining thresholds using wholesale acquisition cost (WAC). Amendment addresses in-network retail and 340B modifiers, preferring flexibility with NCPDP standards. Section seven's timelines are covered by tighter CMS rules; suggests cross-referencing. Section eight should clarify application to plans situs in New Hampshire to avoid extraterritorial impact. Section nine's duty of care to enrollees over health plans and providers creates conflicts, as PBMs contract with plan sponsors; prefers good faith and fair dealing. The out-of-pocket smoothing option is a carrier duty, not PBM. Section ten's preemption effective date should be upon enactment.
SB478 2026135s: Cam LePine, representing American Property Casualty Insurance Association and New Hampshire Association of Domestic Insurance Companies Oppose06:16:14.080 - 2:15:31 PM; Cam LePine, switching hats, raises concerns that the bill's definition may include workers' compensation carriers and requests an exemption, similar to Medicaid exclusion. He also expresses concern about the private right of action for property and casualty carriers.
SB478 2026135s: Morgan Howerin, Director for State Policy with Pharmaceutical Research and Manufacturers of America (PhRMA) Support06:17:09.280 - 2:16:26 PM; Morgan Howerin supports SB478 for prioritizing patients by reforming PBM operations through compensation changes, duty of care, and transparency. PBMs control 80% of the market, using percentage-based formulas tied to list prices or rebates, creating misaligned incentives favoring higher-priced drugs. The bill requires flat service fees not tied to drug prices, bans spread pricing where PBMs pocket differences, and enhances transparency and duty of care to align incentives with patient and plan value, not PBM profit.
SB478 2026135s: Kristen McCon Gordon, Associate Director for Advocacy and Public Policy for Epilepsy Foundation New England Support06:20:45.200 - 2:20:02 PM; Kristen McCon Gordon urges support for SB478 on behalf of over 13,000 New Hampshire residents with epilepsy. Daily medications are essential but costly, leading to skipped doses, seizures, ER visits, and job loss. The bill provides transparency, fairer pricing, and lower costs by addressing PBM compensation, making drugs more affordable for chronic conditions like epilepsy.
SB478 2026135s: Peter Bragden, representing Harvard Pilgrim Healthcare Oppose06:23:52.160 - 2:23:09 PM; Peter Bragden, from a small regional nonprofit insurer without its own PBM, opposes banning spread pricing in section four, as it transfers pricing risks to PBMs, enabling cost savings and lower premiums for self-insured groups. Suggests allowing options like Connecticut's model. Section six on 340B claims needs clarification on modifiers outside federal/state standards. Section nine's interest-free out-of-pocket smoothing is not feasible for insurers, increasing administrative costs and premiums; premiums should cover medically necessary items, not act as a bank.
SB478 2026135s: Unidentified Speaker (likely Henry Litman or similar, discussing bill details) Information Only06:27:57.920 - 2:27:14 PM; The speaker provides analysis on spread pricing models (spread, pass-through, transparent), cautioning against banning spread pricing outright as the market is evolving toward transparency. Advises caution on importing unproven federal smoothing options into commercial plans. On duty of care in section nine, notes it could be reasonable but requires Insurance Department rulemaking to define duties to enrollees, health plans, and providers, which is an unusual burden.
SB478 2026135s: Curtis Barry, representing Pharmaceutical Care Management Association (PCMA) Oppose06:34:14.718 - 2:33:31 PM; Curtis Barry explains PBMs manage pharmacy benefits for plan sponsors like employers and the state, aiming to make benefits less expensive and more robust. Legislation increasing costs could lead to higher co-pays or reduced coverage. The bill applies to the state employees plan per the insurer definition; suggests consulting Department of Administrative Services for fiscal impact. Emphasizes consistency with existing statutes like 420-J and 402-N. Notes carve-outs for Medicaid imply costs for other plans; references another state's experience on fiscal notes.
SB478 2026135s: Sam Hollowire, PCMA Oppose06:38:27.120 - 2:37:44 PM; Sam Hollowire from the Pharmaceutical Care Management Association (PCMA) opposes Senate Bill 478. He emphasizes that no one is required to use a PBM, as plans hire them voluntarily for cost control. He focuses on four key issues: PBM compensation, ERISA concerns, mail order requirements, and conflicting duties of care. Section 4's delinking provision would force flat fee arrangements, limiting performance-based models and potentially reducing rebates from pharmaceutical companies, leading to higher premiums for New Hampshire patients. He cites New Mexico's similar policy that generated a $60 million fiscal note and ultimately failed. The bill does not affect drug prices set by pharma but impacts how plans pay PBMs. The expanded insurer definition under ERISA could improperly regulate self-funded plans. Section 5's mail order restriction interferes with plan sponsors' benefit design choices. Conflicting duties of care create inevitable conflicts between employers, enrollees, and providers. The bill adds a private right of action and would increase costs without lowering drug prices, urged the committee to oppose it.

Rochefort, David(Chairman)(R)[B-]2025	Avard, Kevin(V Chairman)(R)[B]2025	Birdsell, Regina(R)[B-]2025
Prentiss, Suzanne(D)[F]2025	Long, Pat(D)[F]2025