2026 -- H 7189 | |
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LC003517 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2026 | |
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A N A C T | |
RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE -- FAIR | |
COMPETITION AND PRACTICES | |
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Introduced By: Representatives Kislak, Fogarty, McGaw, Boylan, Speakman, Donovan, | |
Date Introduced: January 21, 2026 | |
Referred To: House Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-29.1 of the General Laws entitled "Pharmacy Freedom of Choice |
2 | — Fair Competition and Practices" is hereby amended by adding thereto the following section: |
3 | 27-29.1-12. Fair pharmacy reimbursement and anti-discrimination. |
4 | (a) Reimbursement parity. |
5 | A pharmacy benefit manager shall not reimburse a non-affiliated pharmacy or pharmacist |
6 | in an amount less than the net effective reimbursement, inclusive of all fees, adjustments, |
7 | incentives, and other remuneration, paid directly or indirectly to an affiliated pharmacy or |
8 | pharmacist for the same drug or service. |
9 | (b) Anti-discrimination. |
10 | A pharmacy benefit manager shall not impose contractual terms, reimbursement |
11 | methodologies, performance metrics, or other requirements that have the effect of reimbursing non- |
12 | affiliated pharmacies or pharmacists at a lower rate than affiliated pharmacies or pharmacists for |
13 | the same drug or service. |
14 | (c) Transparency of affiliated reimbursement. |
15 | Upon request by the office of the health insurance commissioner (“OHIC”), a pharmacy |
16 | benefit manager shall provide reimbursement data reasonably necessary to verify compliance with |
17 | this section, including data relating to affiliated pharmacies. |
18 | (d) Enforcement. |
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1 | This section shall be enforced by OHIC and the attorney general pursuant to their existing |
2 | authority under law. |
3 | (e) Medicaid applicability. |
4 | All Medicaid managed care organizations, and all pharmacy benefit managers contracted |
5 | by or on behalf of Medicaid managed care organizations, shall comply with the provisions of this |
6 | section with respect to all Medicaid pharmacy benefits, whether administered directly or through a |
7 | pharmacy benefit manager. |
8 | (f) Prohibition on evasion. |
9 | A pharmacy benefit manager, insurer, or Medicaid managed care organization shall not |
10 | avoid compliance with this section through affiliation structures, subcontracting, differential |
11 | pricing metrics, reimbursement methodologies, or contractual arrangements designed to favor |
12 | affiliated pharmacies or pharmacists. |
13 | (g) Rulemaking. |
14 | The OHIC may promulgate and adopt rules and regulations necessary to implement and |
15 | enforce this section. |
16 | SECTION 2. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE -- FAIR | |
COMPETITION AND PRACTICES | |
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1 | This act would require fair pharmacy reimbursement from a pharmacy benefit manager to |
2 | a non-affiliated pharmacy or pharmacist and also provide anti-discrimination prohibitions by |
3 | pharmacy benefit managers in regard to non-affiliated pharmacies or pharmacists. |
4 | This act would take effect upon passage. |
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