This bill seeks to enhance transparency, oversight, and accountability in the management of pharmacy benefits in Rhode Island, specifically targeting the practices of pharmacy benefit managers (PBMs). It introduces new requirements for PBMs to cease spread pricing, which is a payment model where the PBM charges a health plan more than it reimburses the pharmacy for a prescription drug and retains the difference. Instead, PBMs are required to adopt pass-through pricing, where they charge the health plan or insurer the same amount they reimburse the pharmacy, retaining only a predetermined administrative fee. The bill also mandates that PBMs stop discriminatory treatment of non-affiliated pharmacies and pharmacists, and cease utilization management processes that delay or prevent medically necessary care.

Additionally, the bill ensures that enrollees benefit from discounts, price reductions, or other financial incentives provided to PBMs by drug manufacturers, including rebates for formulary placements. PBMs are required to provide information and documents to the executive office of health and human services or the office of the health insurance commissioner upon request to facilitate enforcement of these provisions.

The Office of the Health Insurance Commissioner (OHIC) is granted the authority to promulgate rules and regulations, employ staff familiar with PBM operations, and 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, stating that if any provision is found unconstitutional or invalid, it will not affect the validity of other parts of the section.

The act takes effect immediately upon passage.

Statutes affected:
5429: 27-20.7-12, 27-29.1-7, 42-14.5-3