This bill aims to enhance the transparency and accountability of pharmacy benefit managers (PBMs) and managed care organizations (MCOs) within the Rhode Island Medicaid program to protect residents from high prescription drug costs. It amends Section 42-7.2-5 of the General Laws, introducing new duties for the secretary of the Executive Office of Health and Human Services (EOHHS). These duties include ensuring that PBMs cease practices such as spread pricing, utilize pass-through pricing, and prohibit discriminatory treatment of non-affiliated pharmacies. Additionally, the bill mandates that any financial incentives from drug manufacturers benefit enrollees and requires PBMs to provide necessary information for enforcement.

Furthermore, the bill requires the secretary to analyze and make recommendations to the governor and the general assembly by January 1, 2026, regarding the structure of Medicaid PBM operations, including the potential creation of a single Medicaid PBM, carving out pharmacy benefits from the managed care program, adopting a uniform preferred prescription drug list, and moving to a Connecticut-style Medicaid program. It also allows for the imposition of civil fines up to ten thousand dollars ($10,000) per violation and emphasizes collaboration with other state authorities to ensure effective oversight of MCOs and PBMs. The act is set to take effect upon passage.

Statutes affected:
5463: 42-7.2-5