This bill amends several chapters of the General Laws related to insurance, specifically focusing on the responsibilities of pharmacy benefit managers (PBMs) regarding the denial of coverage for prescription drugs. It introduces a new section in each relevant chapter that mandates PBMs to provide a written notice containing a "medically sound justification" for any denial of coverage. This notice must be delivered simultaneously to both the prescribing provider and the patient, ensuring that they understand the basis for the denial and can take appropriate action, such as submitting an appeal or requesting prior authorization.

The bill specifies that any medically sound justification must be provided or reviewed by a licensed physician, licensed pharmacist, or other healthcare professional authorized under Rhode Island law to make such clinical determinations. The name and license information of the reviewing professional must be included in the written notice. It defines "medically sound justification" as a reason based on recognized clinical standards or evidence-based guidelines appropriate to the patient's condition.

Furthermore, the bill clarifies that nothing in this section shall prevent a pharmacy benefit manager from denying coverage in accordance with the terms of the insurance plan or prescription drug benefit contract, provided that the written justification requirement and medical oversight requirements are met. The provisions of this act are set to take effect on January 1, 2027.