Requires the secretary of the executive office of health and human services to monitor and mandate changes to the price-setting practices of pharmacy benefit managers to prohibit the spread pricing payment model.
Caps the total amount that a covered person is required to pay for a covered prescription inhaler, prescription device, or prescription equipment to twenty-five dollars ($25.00) per thirty (30) day supply.
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
HB 7816 requires pharmacy benefit managers (PBMs) in Rhode Island to provide written medical justification when denying coverage for prescription drugs. The bill mandates that denials include a detailed, clinically supported reason based on recognized medical standards, reviewed by a licensed healthcare professional, and delivered simultaneously to both the prescribing provider and the patient. It applies to all prescription drug benefit denials under insurance plans governed by Rhode Island law, without changing the terms of the insurance contracts themselves. The law takes effect on January 1, 2027.
Caps amount payable for 30 day supply of equipment/supplies for insulin administration/glucose monitoring at $25 or equipment designed to last more than 30 days with no deductible commencing January 1, 2027.
SB 2386 requires health insurance plans in the state to cover specific pharmacist services starting January 1, 2027. It mandates coverage for services like medication therapy management, immunizations, and medication administration - services that would be covered if provided by physicians - without requiring supervision or referrals from other providers. Insurance plans must include pharmacists in their medical provider networks (distinct from pharmacy drug benefit networks) and cover these services even outside the network when no local provider is available. The law expires on January 1, 2031, unless extended by the legislature. This directly affects insurers, pharmacists, and patients seeking these covered services.
SB 2109 prohibits health insurers and pharmacy benefit managers from requiring or conducting insurance reviews for prescriptions used to treat opioid or alcohol use disorder. Specifically, it blocks reviews for medications containing methadone, buprenorphine, or naltrexone, or for any FDA-approved medication managing opioid withdrawal. The bill directly affects patients seeking addiction treatment and insurers/pharmacy managers handling these prescriptions. It also requires Medicaid managed care organizations to use state-set medical necessity criteria for reviews. The law takes effect upon passage.
Requires health plans that provide prescription benefits to cover at least one type of glucagon auto-injector, nasal spray, or formulation that does not require reconstitution to treat hypoglycemia. No copayment or deductible would be required.
Expands the existing law regarding collaborative practice agreements between pharmacists and physicians to allow other healthcare providers to enter into such agreements and removes the definition of “collaborative practice committee.”
Includes any costs paid by an enrollee or on behalf of the enrollee, by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement, under a health plan as of January 1, 2027.