The bill amends Chapter 27-20.8 entitled "Prescription Drug Benefits" of the General Laws by defining new terms and modifying existing definitions. New definitions include "cost sharing," which encompasses copayments, coinsurance, deductibles, or any annual limitations on cost sharing required for health care services, including prescription drugs. The term "insurer" is expanded to include various entities offering healthcare services on a prepaid basis, such as nonprofit service corporations, health maintenance organizations, and the Rhode Island Medicaid program. Additionally, the term "pharmacy benefit manager" is defined as any person or business administering prescription drug programs on behalf of a third party.

The bill also introduces a new section, 27-20.8-5, titled "Cost sharing calculation," which mandates that when calculating an enrollee's contribution to any out-of-pocket maximum or cost-sharing requirement under a health plan, the insurer or pharmacy benefit manager must include any amounts paid by the enrollee or on behalf of the enrollee by another person. This provision will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2025. The act will take effect upon passage.

Statutes affected:
2720: 27-20.8-1