This bill requires the secretary of the executive office of health and human services (EOHHS) to monitor and mandate changes to the price-setting practices of pharmacy benefit managers (PBMs) within the Rhode Island Medicaid program. It amends Section 42-7.2-5 of the General Laws, outlining the duties of the secretary. Key provisions include ensuring that managed care organizations (MCOs) and PBMs are transparent, do not impose unnecessary costs on the Medicaid program and patients, and demonstrate improvements in patient health outcomes. The bill mandates that contracts with MCOs must prohibit spread pricing, which is a payment model where PBMs charge a health plan more for a prescription drug than what they reimburse the pharmacy, retaining the difference. This act will take effect upon passage.

Statutes affected:
2462: 42-7.2-5