This bill aims to enhance the transparency and accountability of managed care organizations (MCOs) and pharmacy benefit managers (PBMs) in Rhode Island's Medicaid program to protect residents from high prescription drug costs. It amends Section 42-7.2-5 of the General Laws, introducing new duties for the secretary of the Executive Office of Health and Human Services (EOHHS). These duties include ensuring that MCOs and PBMs do not engage in practices that increase costs unnecessarily, such as spread pricing, and require them to adopt pass-through pricing models. The bill mandates that contracts with MCOs include provisions to prohibit discriminatory treatment of non-affiliated pharmacies and to eliminate utilization management processes that delay or prevent access to medically necessary care.

Additionally, the bill requires the EOHHS to analyze and make recommendations by January 1, 2026, regarding the potential creation of a single Medicaid PBM, the separation of pharmacy benefits from managed care, the adoption of a uniform preferred drug list, and the transition to a Connecticut-style Medicaid program. It empowers the EOHHS to promulgate rules and regulations, employ staff familiar with PBM operations, and impose civil fines of up to ten thousand dollars ($10,000) per violation. The overarching goal is to ensure that the Medicaid program operates efficiently and effectively, ultimately improving patient health outcomes while managing costs. The act will take effect upon passage.

Statutes affected:
117: 42-7.2-5