This bill aims to enhance transparency, oversight, and accountability in the management of pharmacy benefits in Rhode Island by regulating pharmacy benefit managers (PBMs) as third-party administrators. It prohibits spread pricing, which allows PBMs to charge health plans more than what they reimburse pharmacies, and mandates the use of pass-through pricing, where PBMs charge health plans the same amount they reimburse pharmacies, retaining only a predetermined administrative fee. The legislation also prohibits discriminatory treatment of non-affiliated pharmacies and requires PBMs to ensure that enrollees benefit from discounts, price reductions, or other financial incentives provided by drug manufacturers.

Additionally, the bill requires PBMs to provide necessary information and documents to the executive office of health and human services or the office of the health insurance commissioner upon request. It introduces new requirements for obtaining a certificate of authority to operate as an administrator, including the submission of proof of an insurance producer license and other pertinent information as required by the commissioner.

The Office of the Health Insurance Commissioner (OHIC) is tasked with promulgating rules and regulations to implement and enforce these provisions and may impose civil fines of up to $10,000 per violation. The bill clarifies that the attorney general retains the authority to take action against PBMs. It includes a severability clause to ensure that if any provision is found unconstitutional or invalid, the remaining provisions will still stand. The act is set to take effect immediately upon passage.

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