The bill aims to enhance transparency and accountability in the pharmacy benefit manager (PBM) sector in Rhode Island by classifying PBMs as third-party administrators, thereby subjecting them to regulatory oversight. Key provisions include the prohibition of spread pricing practices, the adoption of pass-through pricing models, and the elimination of discriminatory treatment towards non-affiliated pharmacies. PBMs are required to ensure that discounts and rebates from drug manufacturers directly benefit enrollees and to provide information and documents for enforcement purposes to the executive office of health and human services or the office of the health insurance commissioner upon request.

The legislation outlines the responsibilities of the Office of the Health Insurance Commissioner (OHIC), which includes promulgating rules and regulations, employing staff familiar with PBM operations, and enforcing the provisions of the bill. The OHIC may impose civil fines of up to ten thousand dollars ($10,000) per violation and is required to consult with various state authorities to ensure effective oversight of PBMs.

Additionally, the bill includes a severability clause, stating that if any provision is found unconstitutional or invalid, it shall be severed without affecting the validity of other parts of the section. The bill takes effect upon passage.

Statutes affected:
221: 27-20.7-12, 27-29.1-7, 42-14.5-3