This bill aims to enhance the transparency and accountability of pharmacy benefit managers (PBMs) within Rhode Island's Medicaid program, ultimately protecting both the state's residents and the Medicaid program from high prescription drug costs. It amends Section 42-7.2-5 of the General Laws, detailing the duties of the secretary of the executive office of health and human services (EOHHS). The bill introduces new provisions that require managed care organizations (MCOs) and PBMs to operate transparently, avoid unnecessary costs, and demonstrate improvements in patient health outcomes. Specifically, it mandates that contracts with MCOs prohibit the practice of spread pricing, where PBMs charge health plans more than what they reimburse pharmacies for prescription drugs, retaining the difference.

The act requires the EOHHS secretary to monitor and mandate changes to the price-setting practices of PBMs to ensure compliance with these provisions. The act is set to take effect upon passage, reflecting a significant step towards reforming the state's approach to managing prescription drug costs and improving healthcare delivery within the Medicaid program.

Statutes affected:
7825: 42-7.2-5