relative to strengthening prescription drug affordability and pharmacy benefits manager accountability.

SB 478 aims to lower prescription drug costs for New Hampshire residents by regulating pharmacy benefit managers (PBMs). It bans "spread pricing" (where PBMs keep the difference between what they pay pharmacies and charge insurers), requires all manufacturer rebates to reduce consumer out-of-pocket costs or premiums, and prohibits retroactive fees on clean claims. The bill also mandates transparent pricing lists, allows audits to prevent misuse, and prioritizes the lowest net-cost drugs in formularies. These changes directly affect patients, pharmacies, insurers, and PBMs by making drug pricing more transparent and reducing hidden costs.