The bill seeks to improve transparency and accountability among pharmacy benefit managers (PBMs) in Rhode Island, aiming to protect residents from high prescription drug costs. It amends Section 27-20.7-12 of the General Laws to stipulate that no individual or entity may act as an administrator without a valid certificate of authority issued by the commissioner, detailing the application process that includes organizational documents, financial statements, and a business plan. The bill also introduces new requirements for administrators to disclose financial arrangements with insurers and notify the commissioner of any material changes. Additionally, it amends Section 27-29.1-7 to include PBMs in the definition of third-party administrators, subjecting them to the same regulatory framework, and prohibits spread pricing while promoting pass-through pricing.

Moreover, the bill establishes a federal high-risk pool structure to mitigate adverse selection and reduce insurance premiums for at-risk populations, requiring collaboration between the health insurance commissioner and a task force of various stakeholders. It also creates a workgroup to streamline healthcare administration processes and enhance the prior authorization process for healthcare services, ensuring clear access to information for providers and patients. The bill mandates the Office of the Health Insurance Commissioner (OHIC) to conduct various assessments and reporting requirements, including compliance with the Mental Health Parity Act and the impact of healthcare mandates on insurance costs. Overall, these provisions aim to create a more equitable and efficient health insurance landscape in Rhode Island while enhancing oversight of social and human service programs.