The bill amends Section 27-20.8-1 of the General Laws regarding "Prescription Drug Benefits" to introduce new definitions and clarify existing terms. Key insertions include the definitions of "cost sharing," "insurer," "person," and "pharmacy benefit manager," which provide a clearer understanding of the roles and responsibilities of various entities involved in health care services. Additionally, the bill specifies that "cost sharing" encompasses copayments, coinsurance, deductibles, and annual limitations required for receiving health care services, including prescription drugs.

Furthermore, the bill adds a new section, 27-20.8-5, which mandates that when calculating an enrollee's out-of-pocket maximum or cost-sharing requirements, insurers or pharmacy benefit managers must include amounts paid by the enrollee or on their behalf for certain prescriptions. This requirement applies to health plans entered into or renewed after January 1, 2026. The bill aims to enhance transparency and fairness in cost-sharing calculations, ensuring that enrollees receive appropriate credit for their contributions towards their health care expenses. The act will take effect upon passage.