2025 -- H 5627

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LC001434

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Casimiro, Noret, Read, Spears, McGaw, and Solomon

     Date Introduced: February 26, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-95. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services

within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists'

services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan

would have provided coverage if the service had been performed by a physician, advanced practice

nurse, or physician assistant. No nonprofit medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement to a

pharmacist; provided that, no nonprofit medical service corporation may be required to pay for

duplicative services actually rendered by both a pharmacist and any other healthcare provider. The

following services shall qualify as being eligible for payment and reimbursement to a pharmacist,

unless paid by another mechanism, include:

     (1) Evaluation and management of a patient, which requires a medically appropriate history

and/or examination and medical decision making;

     (2) Medication therapy management review;

     (3) Immunization education and administration;

     (4) Administration of medications; and

     (5) Ordering and evaluation of clinical laboratory tests.

     (b) The health plan shall include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

shall not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this section apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits required by the provisions of this section outside of the health insurer's

provider network where it can be established that the required services are not available from a

provider in the health insurer's network.

     (d) The provisions of this section shall sunset and expire on January 1, 2030, unless

extended by the general assembly.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-87. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services

within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists'

services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan

would have provided coverage if the service had been performed by a physician, advanced practice

nurse, or physician assistant. No nonprofit medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement to a

pharmacist; provided that, no nonprofit medical service corporation may be required to pay for

duplicative services actually rendered by both a pharmacist and any other healthcare provider. The

following services shall qualify as being eligible for payment and reimbursement to a pharmacist,

unless paid by another mechanism, include:

     (1) Evaluation and management of a patient, which requires a medically appropriate history

and/or examination and medical decision making;

     (2) Medication therapy management review;

     (3) Immunization education and administration;

     (4) Administration of medications; and

     (5) Ordering and evaluation of clinical laboratory tests.

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     (b) The health plan shall include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

shall not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this section apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits required by the provisions of this section outside of the health insurer's

provider network where it can be established that the required services are not available from a

provider in the health insurer's network.

     (d) The provisions of this section shall sunset and expire on January 1, 2030, unless

extended by the general assembly.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-83. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services

within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists'

services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan

would have provided coverage if the service had been performed by a physician, advanced practice

nurse, or physician assistant. No nonprofit medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement to a

pharmacist; provided that, no nonprofit medical service corporation may be required to pay for

duplicative services actually rendered by both a pharmacist and any other healthcare provider. The

following services shall qualify as being eligible for payment and reimbursement to a pharmacist,

unless paid by another mechanism, include:

     (1) Evaluation and management of a patient, which requires a medically appropriate history

and/or examination and medical decision making;

     (2) Medication therapy management review;

     (3) Immunization education and administration;

     (4) Administration of medications; and

     (5) Ordering and evaluation of clinical laboratory tests.

     (b) The health plan shall include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

LC001434 - Page 3 of 7

shall not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this section apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits required by the provisions of this section outside of the health insurer's

provider network where it can be established that the required services are not available from a

provider in the health insurer's network.

     (d) The provisions of this section shall sunset and expire on January 1, 2030, unless

extended by the general assembly.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-100. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services

within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists'

services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan

would have provided coverage if the service had been performed by a physician, advanced practice

nurse, or physician assistant. No nonprofit medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement to a

pharmacist; provided that, no nonprofit medical service corporation may be required to pay for

duplicative services actually rendered by both a pharmacist and any other healthcare provider. The

following services shall qualify as being eligible for payment and reimbursement to a pharmacist,

unless paid by another mechanism, include:

     (1) Evaluation and management of a patient, which requires a medically appropriate history

and/or examination and medical decision making;

     (2) Medication therapy management review;

     (3) Immunization education and administration;

     (4) Administration of medications; and

     (5) Ordering and evaluation of clinical laboratory tests.

     (b) The health plan shall include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

shall not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

LC001434 - Page 4 of 7

     (c) The healthcare benefits outlined in this section apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits required by the provisions of this section outside of the health insurer's

provider network where it can be established that the required services are not available from a

provider in the health insurer's network.

     (d) The provisions of this section shall sunset and expire on January 1, 2030, unless

extended by the general assembly.

     SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

amended by adding thereto the following section:

     40-8-33. Coverage for pharmacists' services.

     (a) The executive office of health and human services is directed and authorized to establish

coverage for the services within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-

2, and pharmacists' services provided under a "collaborative practice agreement" defined in § 5-

19.2-2, if the plan would have provided coverage if the service had been performed by a physician,

advanced practice nurse, or physician assistant. The following services would qualify as being

eligible for payment and reimbursement to a pharmacist, unless paid by another mechanism,

include:

     (1) Evaluation and management of a patient, which requires a medically appropriate history

and/or examination and medical decision making;

     (2) Medication therapy management review;

     (3) Immunization education and administration;

     (4) Administration of medications; and

     (5) Ordering and evaluation of clinical laboratory tests.

     (b) The health plan shall include pharmacists in its network of participating medical

providers. The participation of pharmacies in the plan network's drug benefit shall not satisfy the

requirement that plans include pharmacists in their networks of participating medical providers.

     (c) The healthcare benefits outlined in this section apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits required by the provisions of this section outside of the health insurer's

provider network where it can be established that the required services are not available from a

provider in the health insurer's network.

     (d) The executive office of health and department of human services shall apply to the

United States department of health and human services for any amendment to the state Medicaid

plan or for any Medicaid waiver as necessary to implement this section. The executive office of

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health and human services shall submit the Medicaid state plan amendment not later than

September 1, 2025.

     (e) The provisions of this section shall sunset and expire on January 1, 2030, unless

extended by the general assembly.

     SECTION 6. This act shall take effect on January 1, 2026, and unless extended by the

general assembly, shall expire on January 1, 2030.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would require health insurance providers to provide insurance coverage for

pharmacists’ services including evaluation and management of a patient, which requires a

medically appropriate history and/or examination and medical decision making; medication

therapy management review; immunization education and administration; administration of

medications; ordering and evaluation of clinical laboratory tests.

     This act would take effect on January 1, 2026, and unless extended by the general assembly,

would expire on January 1, 2030.

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