This bill aims to enhance the transparency and accountability of pharmacy benefit managers (PBMs) and managed care organizations (MCOs) within Rhode Island's Medicaid program, with the goal of controlling prescription drug costs and improving patient health outcomes. Key provisions include the requirement for contracts with MCOs to ensure that PBMs cease practices such as spread pricing, where the PBM charges health plans more than what pharmacies are reimbursed for medications. The bill mandates that PBMs utilize pass-through pricing, prohibit discriminatory treatment of non-affiliated pharmacies, and eliminate utilization management processes that delay or prevent access to medically necessary care.

Additionally, the bill outlines the responsibilities of the Secretary of the Executive Office of Health and Human Services (EOHHS), which include ensuring that MCOs and PBMs do not increase unnecessary costs for the Medicaid program and patients. The Secretary is tasked with analyzing and making recommendations to the governor and the General Assembly by January 1, 2027, regarding the creation of a single Medicaid PBM, carving out pharmacy benefits from the managed care program, adopting a uniform preferred drug list, and considering a Connecticut-style Medicaid program. The Secretary is also responsible for promulgating rules and regulations, employing staff familiar with PBM operations, and imposing civil fines for violations.

The act will take effect upon passage.

Statutes affected:
7692: 42-7.2-5