This bill seeks to improve the transparency and accountability of pharmacy benefit managers (PBMs) in Rhode Island, particularly in relation to the state's Medicaid program. It amends Section 42-7.2-5 of the General Laws, enhancing the responsibilities of the Secretary of the Executive Office of Health and Human Services (EOHHS). Key insertions include the requirement for the Secretary to conduct biennial reviews of Medicaid eligibility criteria, prepare an annual overview of Medicaid expenditures, and oversee compliance with federal and state laws. The bill also emphasizes the Secretary's role in resolving departmental conflicts, implementing service quality reforms, and promoting consumer-centered approaches.

Additionally, the bill introduces provisions aimed at ensuring that managed care organizations (MCOs) and PBMs operate transparently within the Rhode Island Medicaid program. It mandates the cessation of spread pricing practices, the implementation of pass-through pricing, and prohibits discriminatory treatment of non-affiliated pharmacies. The legislation also focuses on program integrity, quality control, and the centralization of legal functions, while allowing for sliding scale benefits based on income rather than fixed eligibility thresholds. Overall, the bill is designed to enhance the management of health and human services in Rhode Island, ensuring effective and equitable delivery of healthcare services.

Statutes affected:
5463: 42-7.2-5