For too long, Granite Staters have been asked to navigate the health care system blindfolded — forced to accept prices they cannot see, pharmacy costs they cannot predict, and industry practices they cannot reasonably understand. Families and small businesses are paying more every year while receiving less clarity, less value, and too often worse outcomes. This legislative session, New Hampshire has an opportunity to restore honesty and accountability in health care and put patients first.
To accomplish this, I introduced three complementary bills: the Health Care Price Transparency Act (SB 476), the Sunshine in Savings Act (SB 477), and the Prescription Drug Affordability and PBM Accountability Act (SB 478). Each addresses a different structural failure — prices hidden from consumers, opaque use of 340B savings, and pharmacy benefit manager incentives that drive drug costs higher. Together, they realign the health care marketplace around affordability, transparency, and patient outcomes.
SB 476 delivers practical, enforceable price transparency. Today, patients can receive the same procedure at two hospitals and pay dramatically different prices without any ability to compare. SB 476 aligns our state with federal transparency rules and requires hospitals to provide accurate, good-faith estimates before care. It also requires insurers to show patients their actual out-of-pocket costs using tools insurers already maintain under federal Transparency in Coverage standards.
This is not new bureaucracy; it is the enforcement of a promise already made to consumers. When patients can see real prices, they make informed decisions. When employers can compare costs, insurers must compete. And when hospitals know prices will be visible, unjustified variation becomes harder to defend. Transparency lowers costs while strengthening trust in the system.
SB 477, the Sunshine in Savings Act, brings long-needed visibility to the federal 340B drug discount program. Rural hospitals and community health centers depend on 340B savings to support charity care, behavioral health, and essential services, but patients have no insight into how savings are used. SB 477 requires hospitals to report aggregate information — never proprietary pricing — on how 340B savings support patient care. It also establishes claim-level identifiers to prevent duplicate discounts and introduces rural benefit planning for hospitals with large 340B margins. These reforms strengthen the program, protect rural access, and restore public confidence without undermining hospital finances.
The most sweeping reforms come from SB 478, which takes aim at the opaque, rebate-driven incentives that dominate prescription drug pricing. Pharmacy benefit managers, or PBMs, often profit from high list prices and hidden spreads rather than from lowering costs for patients. SB 478 ends spread pricing in New Hampshire, requires pass-through pricing, and delinks PBM compensation entirely from drug prices. Instead of being rewarded when drug prices rise, PBMs will earn revenue only for services they deliver. All rebates and concessions will flow to reduce premiums or lower the prices patients pay at the pharmacy counter.
The bill also ensures patients receive the lowest net-cost drugs, including biosimilars, prohibits retroactive pharmacy clawbacks, and allows patients to smooth out-of-pocket payments interest-free across the year. SB 478 realigns incentives across the prescription drug supply chain, directly lowering costs and improving access.
Predictably, some industry interests object to these reforms. Large insurers argue that transparency is burdensome. Hospital systems fear sunlight will create competitive pressure. Pharmaceutical middlemen warn PBM reforms will disrupt existing arrangements. But these arguments protect entrenched business models, not patients. Insurers already possess the data SB 476 requires them to show. Hospitals already track how 340B savings are used. PBMs already operate pass-through models in other states because they reduce costs.
The claim that transparency will confuse consumers or that accountability will raise premiums has been disproven wherever reforms like these have been implemented.
New Hampshire families deserve clarity when they access health care, honesty in how savings are used, and a pharmacy system aligned with their well-being — not corporate profit margins. They deserve to know the cost of care before they receive it. They deserve confidence that drug discount programs support local access and affordability. They deserve medications priced according to clinical value, not according to the size of a rebate check.
Passing this legislative package is not a partisan exercise. It is a commitment to making health care affordable and predictable for every resident, from young families to retirees and from small businesses to rural communities. When transparency becomes standard, prices stabilize. When incentives reward value, outcomes improve. And when patients are put first, the entire system begins to work as it should.
New Hampshire has an opportunity to lead the nation with a model grounded in sunlight, fairness, and common sense. These bills provide that foundation. Now it is time to act.
