2026 -- H 7814

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LC005681

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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 FOOD AND DRUGS -- PRESCRIPTION BENEFIT MANAGER

ACCOUNTABILITY ACT

     Introduced By: Representative Charlene Lima

     Date Introduced: February 26, 2026

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 21 of the General Laws entitled "FOOD AND DRUGS" is hereby

amended by adding thereto the following chapter:

CHAPTER 38

PRESCRIPTION BENEFIT MANAGER ACCOUNTABILITY ACT

     21-38-1. Short title.

     This act shall be known and may be cited as "Prescription Benefit Manager Accountability

Act".

     21-38-2. Definitions.

     (a) "Prescription benefit manager" or "PBM" means any person or entity that administers

or manages prescription drug benefits on behalf of a health insurer, health plan, or other third party

payer.

     (b) "Prescribing practitioner" means a physician or other health care provider licensed and

authorized under the laws of this state to prescribe prescription medications.

     21-38-3. Mandatory fulfillment of prescribed medication.

     (a) Whenever a prescribing practitioner prescribes a specific medication for a patient, the

prescription benefit manager or any entity responsible for processing or approving the prescription

shall approve and authorize coverage of that specific medication as written if the prescribing

practitioner submits a notarized letter stating:

     (1) The medical necessity for the specific medication prescribed; and

     (2) That alternative medications are not as effective or are not clinically appropriate for the

patient.

     (b) Upon receipt of the notarized letter described in subsection (a) of this section, the

prescription benefit manager shall not substitute, deny, or require step therapy for a different

medication.

     21-38-4. Denial requirements and medical review.

     (a) Any denial of a prescribed medication shall be made only after review by a licensed

health care professional with documented medical expertise in the specific medication or the

medical condition for which it is prescribed.

     (b) The prescription benefit manager shall document, at the time of denial:

     (1) The name, license number, and specialty of the reviewing health care professional;

     (2) The relevant medical expertise; and

     (3) The clinical basis for the denial.

     (c) Such documentation shall be provided to the prescribing practitioner and the patient

upon request.

     21-38-5. Enforcement.

     (a) Any violation of this chapter shall constitute an unfair or deceptive act or practice and

may be enforced by the attorney general.

     (b) The department of health may promulgate rules and regulations necessary to implement

this chapter.

     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 FOOD AND DRUGS -- PRESCRIPTION BENEFIT MANAGER

ACCOUNTABILITY ACT

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     This act would require prescription benefit managers to approve a specific medication

prescribed by a doctor when supported by a notarized medical necessity letter and require that any

denial be reviewed and documented by a licensed medical expert.

     This act would take effect upon passage.

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