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, inserting new language that clarifies the Secretary of the Executive Office of Health and Human Services (EOHHS) responsibilities, including coordinating healthcare benefits, overseeing Medicaid reform, and ensuring compliance with relevant laws. The bill mandates biennial reviews of Medicaid eligibility criteria and requires the Secretary to prepare an annual report on Medicaid expenditures, outcomes, and utilization rates. While specific deletions from current law are not detailed, the focus is on enhancing the Secretary's role and improving the management of health services.

Additionally, the bill introduces significant provisions aimed at ensuring transparency among managed care organizations (MCOs) and PBMs within the Rhode Island Medicaid program. It specifically prohibits the spread pricing model, which allows PBMs to profit from the difference between what they charge health plans and what they reimburse pharmacies for prescription drugs. This measure is intended to promote fair pricing practices and improve patient health outcomes. The act will take effect upon passage, reflecting a commitment to enhancing the efficiency and integrity of health and human services in the state.

Statutes affected:
5498: 42-7.2-5