Bill Sponsors
Representative Justine A. Caldwell
Committee
House Health & Human Services
Summary
Select
This bill transfers the regulation of pharmacy benefit managers (PBMs) from the Department of Business Regulation to the Office of the Health Insurance Commissioner. It sets new rules for PBMs, requiring them to act in good faith and hold funds in trust. It bans PBMs from preventing pharmacists from telling customers about cheaper alternative drug prices and prohibits them from charging copayments that are higher than the drug's actual cost. Additionally, it requires PBMs to disclose financial information, like rebates and fees, to insurance companies and establishes a process for pharmacies to appeal drug pricing disputes.
Sponsor
Analysis
Pros for Progressives
- Protects consumers from price gouging by banning pharmacy benefit managers from charging copayments that exceed the actual cost of the prescription drug.
- Increases corporate accountability by imposing a strict duty of good faith, care, and transparency on massive pharmacy benefit managers, forcing them to disclose hidden fees and conflicts of interest.
- Empowers pharmacists to help disadvantaged patients by outlawing "gag clauses," ensuring that patients can always be informed of the cheapest available prices for their medications.
Cons for Progressives
- Delays implementation significantly, as the bill does not take effect until January 1, 2027, postponing immediate relief for consumers struggling with high prescription drug costs.
- Fails to directly cap the overall price of prescription drugs set by pharmaceutical manufacturers, leaving a major driver of systemic healthcare costs unaddressed.
- Relies heavily on market transparency and reporting to insurers rather than establishing strict, government-mandated price controls or creating a public option for prescription benefits.
Pros for Conservatives
- Promotes free-market competition by banning gag clauses, allowing pharmacies to freely disclose cash prices and alternative options to consumers without facing corporate retaliation.
- Protects small businesses (independent pharmacies) by establishing a fair appeals process for generic drug pricing and preventing predatory clawbacks by massive PBM corporations.
- Shifts enforcement costs directly to the PBMs and insurers being regulated, ensuring that the financial burden of government oversight is not placed on the general taxpayer.
Cons for Conservatives
- Expands government regulation of private business contracts by strictly dictating how PBMs must report their financial data, rebates, and fees to insurers.
- Grants broad new rule-making authority to the health insurance commissioner to define and limit the duties and obligations of PBMs, expanding the administrative state.
- Imposes strict fiduciary-like duties on PBMs to act with "care, skill, prudence, diligence, and professionalism," which could lead to increased litigation and compliance costs for private businesses.
Constitutional Concerns
None Likely. The legislation regulates commercial contracts and business practices of pharmacy benefit managers, which falls well within the state's police power to regulate insurance and healthcare markets. The requirement for PBMs to hold funds in trust and disclose financial information does not appear to violate due process or equal protection, and banning gag clauses actually promotes, rather than restricts, commercial speech.
Impact Overview
Groups Affected
- Pharmacy benefit managers
- Pharmacists
- Health insurers
- Covered individuals
- Office of the Health Insurance Commissioner
Towns Affected
All
Cost to Taxpayers
Pharmacy Benefit Managers and Insurers: 150% of enforcement personnel salaries/benefits, plus technology, training, and expert costs. General Taxpayers: None.
Revenue Generated
Amount unknown (Surplus enforcement funds will be deposited into the health insurance market integrity fund restricted receipt account)
BillBuddy Impact Ratings
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Freedom Impact
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Public Services
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Regulatory
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Clarity of Bill Language
How clear the language of the bill is. Higher ambiguity equals a lower score.
Enforcement Provisions
Measures enforcement provisions and penalties for non-compliance (if applicable).
Environmental Impact
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Privacy Impact
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Bill Status
Current Status
Held
Comm Passed
Floor Passed
Law
History
• 05/26/2026 Introduced, referred to House Health & Human Services
• 05/26/2026 Scheduled for hearing and/or consideration (05/28/2026)
• 05/28/2026 Committee recommended measure be held for further study
• 06/02/2026 Scheduled for consideration (06/04/2026)
• 06/02/2026 Proposed Substitute
• 05/26/2026 Scheduled for hearing and/or consideration (05/28/2026)
• 05/28/2026 Committee recommended measure be held for further study
• 06/02/2026 Scheduled for consideration (06/04/2026)
• 06/02/2026 Proposed Substitute
Bill Text
SECTION 1. Sections 27-29.1-1, 27-29.1-2, 27-29.1-7, 27-29.1-10 and 27-29.1-11 of the General Laws in Chapter 27-29.1 entitled "Pharmacy Freedom of Choice — Fair Competition and Practices" are hereby amended to read as follows:
27-29.1-1. Definitions.
For purposes of this chapter, the following terms shall mean:
(1)“Director” shall mean the director of the department of business regulation.
(2) “Eligible bidder” shall mean a retail pharmacy, community pharmacy, or pharmacy department registered pursuant to chapter 19.1 of title 5, irrespective of corporate structure or number of locations at which it conducts business, located within the geographical service area of a carrier and willing to bid for participation in a restricted pharmacy network contract.
(3)(2) “Insured” or "covered individual" shall mean any person who is entitled to have pharmacy services paid by an insurer pursuant to a policy, certificate, contract, or agreement of insurance or coverage.
(4)(3) “Insurer” shall mean an insurance carrier as defined in chapters 18, 19, 20, and 41 of this title.
(5)(4) “Nonrestricted pharmacy network” shall mean a network that permits any pharmacy to participate on substantially uniform terms and conditions established by an insurer or pharmacy benefits manager pharmacy benefit manager.
(5) "Health insurance commissioner" or "commissioner" shall mean the office of health insurance commissioner.
(6)“Pharmacy benefits manager” "Pharmacy benefit manager" or "PBM" shall mean any person or entity who or that is not licensed in Rhode Island as an insurer and that develops or manages pharmacy benefits, pharmacy network contracts, or the pharmacy benefit bid process have the meaning provided in § 27-19-26.2.
(7) “Pharmacy benefit management services” shall mean the management or administration of prescription drug benefits for an insurer, directly or through another entity, and regardless of whether the pharmacy benefit manager and the insurer are related, or associated by ownership, common ownership, organization or otherwise. Such management or administration includes, but is not limited to:
(i) The administration or management of prescription drug benefits;
(ii) Claims processing, retail network management, or payment of claims to pharmacies for dispensing prescription drugs;
(iii) Clinical or other formulary or preferred drug list development or management;
(iv) Negotiation or administration of rebates, discounts, payment differentials, or other incentives, for the inclusion of particular prescription drugs in a particular category or to promote the placement of particular prescription drugs on a formulary or preferred drug list;
(v) Patient compliance, therapeutic intervention, or generic substitution programs;
(vi) Disease management;
(vii) Drug utilization review or prior authorization;
(viii) Adjudication of appeals or grievances related to prescription drug coverage;
(ix) Contracting with network pharmacies; and
(x) Controlling the cost of covered prescription drugs.
(7)(8) “Restricted pharmacy network” shall mean an arrangement for the provision of pharmaceutical drug services to insureds that under the terms of an insurer’s policy, certificate, contract, or agreement of insurance or coverage requires an insured or creates a financial incentive for an insured to obtain prescription drug services from one or more participating pharmacies that have entered into a specific contractual relationship with the carrier.
(9) "Spread pricing" shall mean any amount charged or claimed by a pharmacy benefit manager for a prescription drug that exceeds the amount paid by the pharmacy benefit manager to a pharmacy or pharmacist for the dispensing of the prescription drug.
27-29.1-2. Requirement for availability and accessibility of pharmacy services.
In accordance with § 23-17.13-3 [repealed], an An insurer must demonstrate to the director LC006502 - Page 2 of 8 health insurance commissioner of health the willingness and potential ability to ensure that pharmacy services will be provided in a manner to ensure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility, and continuity of service.
27-29.1-7. Regulation of pharmacy benefit managers.
(a)Pharmacy benefits managers Pharmacy benefit manager shall be included within the definition of third-party administrator under chapter 20.7 of this title and shall be regulated in accordance with chapter 84 of this title as such. The annual report filed by third-party administrators with the department of business regulation shall include: contractual language that provides a complete description of the financial arrangements between the third-party administrator and each of the insurers covering benefit contracts delivered in Rhode Island; and if the third-party administrator is owned by or affiliated with another entity or entities, it shall include an organization chart and brief description that shows the relationships among all affiliates within a holding company or otherwise affiliated. The reporting shall be in a format required by the director and filed with the department as a public record as defined and regulated under chapter 2 of title 38.
(b) A pharmacy benefit manager shall not substitute or cause the substitution of one prescription drug for another in dispensing a prescription including, but not limited to, a generic or therapeutically equivalent drug, or alter or cause the altering of the terms of a prescription, without the approval of the prescriber or as explicitly required or permitted by law, including regulations of the health insurance commissioner or board of pharmacy and department of health.
(c) No pharmacy benefit manager shall, with respect to contracts between such pharmacy benefit manager and a pharmacy or, alternatively, such pharmacy benefit manager and a pharmacy's contracting agent including, but not limited to, a pharmacy services administrative organization:
(1) Prohibit or penalize a pharmacist or pharmacy from disclosing to an individual purchasing a prescription medication or service information regarding:
(i) The cost of the prescription medication or service to the individual, or the cost of the prescription medication or service to the pharmacy and the pharmacy's reimbursement for that prescription medication or service; or
(ii) The availability of any therapeutically equivalent alternative medications or alternative methods of purchasing the prescription medication including, but not limited to, paying a cash price; or
(2) Charge or collect from an individual a copayment that exceeds the total submitted charges by the pharmacy for which the pharmacy is paid. If an individual pays a copayment, the LC006502 - Page 3 of 8 pharmacy shall retain the adjudicated costs and the pharmacy benefit manager shall not redact or recoup the adjudicated cost.
(d) A pharmacy benefit manager, with respect to contracts between a pharmacy benefit manager and a pharmacy or, alternatively, a pharmacy benefit manager and a pharmacy's contracting agent including, but not limited to a pharmacy services administrative organization, shall include a reasonable process to appeal, investigate and resolve disputes regarding multi-source generic drug pricing. The appeals process shall include the following provisions:
(1) The right to appeal by the pharmacy and/or the pharmacy's contracting agent shall be limited to fifteen (15) days following the initial claim submitted for payment;
(2) A telephone number through which a network pharmacy may contact the pharmacy benefit manager for the purpose of filing an appeal and an electronic mail address of the individual who is responsible for processing appeals;
(3) The pharmacy benefit manager shall send an electronic mail message acknowledging receipt of the appeal. The pharmacy benefit manager shall respond in an electronic message to the pharmacy and/or the pharmacy's contracting agent filing the appeal within fifteen (15) days indicating its determination. If the appeal is determined to be valid, the maximum allowable cost for the drug shall be adjusted for the appealing pharmacy effective as of the date of the original claim for payment. The pharmacy benefit manager shall require the appealing pharmacy to reverse and rebill the claim in question in order to obtain the corrected reimbursement;
(4) If an update to the maximum allowable cost is warranted, the pharmacy benefit manager or insurer shall adjust the maximum allowable cost of the drug effective for all similarly situated pharmacies in its network in the state effective no later than one day after the date the appeal was determined to be valid; and
(5) If an appeal is denied, the pharmacy benefit manager shall provide the reason for the denial and identify the national drug code of a therapeutically equivalent drug, as determined by the federal Food and Drug Administration, that is available and in adequate supply for purchase by pharmacies in this state from wholesalers at a price which is equal to or less than the maximum allowable cost for that drug as determined by the pharmacy benefit manager.
27-29.1-10. Costs of enforcement.
The total cost of the enforcement under this chapterof §§ 27-29.1-3 and 27-29.1-8 shall be borne by the pharmacy benefits manager(s) pharmacy benefit manager(s) and/or the insurer(s) against whom the complaint investigation, examination or enforcement action is made on an equal basis and shall include, without limitation, the following expenses:
(1) One hundred fifty percent (150%) of the total salaries and benefits paid to the personnel LC006502 - Page 4 of 8 of thedepartment of business regulation office of health insurance commissioner engaged in the enforcement less any salary reimbursement;
(2) All reasonable technology costs related to the enforcement process. Technology costs shall include the actual cost of software and hardware utilized in the enforcement process and the cost of training personnel in the proper use of the software or hardware;
(3) All necessary and reasonable education and training costs incurred by the state to maintain the proficiency and competence of the enforcing personnel. All these costs shall be incurred in accordance with the appropriate state of Rhode Island regulations, guidelines, and procedures.;
(4) Any reasonable expenses of any experts, consultants, and contractors retained by the health insurance commissioner; and
(5) Any and all funds collected from other enforcement actions from this title levied against pharmacy benefit managers determined by the health insurance commissioner to be surplus, shall be deposited into the health insurance market integrity fund restricted receipt account established pursuant to § 42-157.1-5.
27-29.1-11. Evaluation report.
The health insurance commissioner, pursuant to § 42-14.5-1, shall evaluate the impact of nonrestricted pharmacy networks pharmacy benefit manager practices and operations on health insurance costs in Rhode Island and shall submit a report of findings to the joint legislative committee on health care oversight on or before May 1, 2005 and recommendations to the general assembly on or before March 31, 2027.
SECTION 2. Chapter 27-29.1 of the General Laws entitled "Pharmacy Freedom of Choice — Fair Competition and Practices" are hereby amended by adding thereto the following sections:
27-29.1-12. Duty, accountability, and transparency of pharmacy benefit managers.
(a)(1) The pharmacy benefit manager shall have a duty and obligation to perform pharmacy benefit management services with care, skill, prudence, diligence, and professionalism.
(2) A pharmacy benefit manager interacting with a covered individual shall have the same duty to a covered individual as the insurer for whom it is performing pharmacy benefit management services.
(3) A pharmacy benefit manager shall have a duty of good faith and fair dealing with all parties including, but not limited to, covered individuals and pharmacies, with whom it interacts in the performance of pharmacy benefits management services.
(b) All funds received by the pharmacy benefit manager in relation to providing pharmacy benefit management services shall be received by the pharmacy benefit manager in trust and shall LC006502 - Page 5 of 8 be used or distributed only pursuant to the pharmacy benefit manager's contract with the insurer or applicable law; including any administrative fee or payment to the pharmacy benefit manager expressly provided for in the contract to compensate the pharmacy benefit manager for its services. Any funds received by the pharmacy benefit manager through spread pricing shall be subject to this section.
(c) Beginning August 1, 2027, a pharmacy benefit manager shall provide to an insurer for whom it is providing pharmacy benefit services:
(1) Any pricing discounts, rebates of any kind, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits received by the pharmacy benefit manager. The insurer shall have access to all financial and utilization information of the pharmacy benefit manager in relation to pharmacy benefit management services provided to the insurer;
(2) The terms and conditions of any contract or arrangement between the pharmacy benefit manager and any party relating to pharmacy benefit management services provided to the insurer including, but not limited to, dispensing fees paid to the pharmacies; and
(3) Any activity, policy, practice, contract or arrangement of the pharmacy benefit manager that directly or indirectly presents any conflict of interest with the pharmacy benefit manager's relationship with or obligation to the insurer.
(d) Beginning August 1, 2028, reports required to be provided under the Consolidated Appropriation Act of 2026, and subsequent regulations, shall be deemed sufficient to comply with the requirements of this subsection.
(e) Any information required to be disclosed by a pharmacy benefit manager to an insurer under this section that is reasonably designated by the pharmacy benefit manager as proprietary or trade secret information shall be kept confidential by the insurer, except as required or permitted by law, including disclosure necessary to prosecute or defend any legitimate legal claim or cause of action. Designation of information as proprietary or trade secret information under this subsection shall have no effect on the obligations of any pharmacy benefit manager or insurer to provide that information to the office of health insurance commissioner, provided any such information provided to the office of health insurance commissioner shall be confidential and exempt from disclosure under § 38-2-2.
27-29.1-13. Rules and regulations.
The health insurance commissioner shall promulgate rules and regulations necessary to effectuate the purpose of this chapter, including, defining, limiting, and relating to the duties, obligations, requirements and other provisions relating to pharmacy benefit managers. LC006502 - Page 6 of 8
SECTION 3. This act shall take effect on January 1, 2027.
27-29.1-1. Definitions.
For purposes of this chapter
(1)
(5) "Health insurance commissioner" or "commissioner" shall mean the office of health insurance commissioner.
(6)
(7) “Pharmacy benefit management services” shall mean the management or administration of prescription drug benefits for an insurer, directly or through another entity, and regardless of whether the pharmacy benefit manager and the insurer are related, or associated by ownership, common ownership, organization or otherwise. Such management or administration includes, but is not limited to:
(i) The administration or management of prescription drug benefits;
(ii) Claims processing, retail network management, or payment of claims to pharmacies for dispensing prescription drugs;
(iii) Clinical or other formulary or preferred drug list development or management;
(iv) Negotiation or administration of rebates, discounts, payment differentials, or other incentives, for the inclusion of particular prescription drugs in a particular category or to promote the placement of particular prescription drugs on a formulary or preferred drug list;
(v) Patient compliance, therapeutic intervention, or generic substitution programs;
(vi) Disease management;
(vii) Drug utilization review or prior authorization;
(viii) Adjudication of appeals or grievances related to prescription drug coverage;
(ix) Contracting with network pharmacies; and
(x) Controlling the cost of covered prescription drugs.
(9) "Spread pricing" shall mean any amount charged or claimed by a pharmacy benefit manager for a prescription drug that exceeds the amount paid by the pharmacy benefit manager to a pharmacy or pharmacist for the dispensing of the prescription drug.
27-29.1-2. Requirement for availability and accessibility of pharmacy services.
27-29.1-7. Regulation of pharmacy benefit managers.
(a)
(b) A pharmacy benefit manager shall not substitute or cause the substitution of one prescription drug for another in dispensing a prescription including, but not limited to, a generic or therapeutically equivalent drug, or alter or cause the altering of the terms of a prescription, without the approval of the prescriber or as explicitly required or permitted by law, including regulations of the health insurance commissioner or board of pharmacy and department of health.
(c) No pharmacy benefit manager shall, with respect to contracts between such pharmacy benefit manager and a pharmacy or, alternatively, such pharmacy benefit manager and a pharmacy's contracting agent including, but not limited to, a pharmacy services administrative organization:
(1) Prohibit or penalize a pharmacist or pharmacy from disclosing to an individual purchasing a prescription medication or service information regarding:
(i) The cost of the prescription medication or service to the individual, or the cost of the prescription medication or service to the pharmacy and the pharmacy's reimbursement for that prescription medication or service; or
(ii) The availability of any therapeutically equivalent alternative medications or alternative methods of purchasing the prescription medication including, but not limited to, paying a cash price; or
(2) Charge or collect from an individual a copayment that exceeds the total submitted charges by the pharmacy for which the pharmacy is paid. If an individual pays a copayment, the LC006502 - Page 3 of 8 pharmacy shall retain the adjudicated costs and the pharmacy benefit manager shall not redact or recoup the adjudicated cost.
(d) A pharmacy benefit manager, with respect to contracts between a pharmacy benefit manager and a pharmacy or, alternatively, a pharmacy benefit manager and a pharmacy's contracting agent including, but not limited to a pharmacy services administrative organization, shall include a reasonable process to appeal, investigate and resolve disputes regarding multi-source generic drug pricing. The appeals process shall include the following provisions:
(1) The right to appeal by the pharmacy and/or the pharmacy's contracting agent shall be limited to fifteen (15) days following the initial claim submitted for payment;
(2) A telephone number through which a network pharmacy may contact the pharmacy benefit manager for the purpose of filing an appeal and an electronic mail address of the individual who is responsible for processing appeals;
(3) The pharmacy benefit manager shall send an electronic mail message acknowledging receipt of the appeal. The pharmacy benefit manager shall respond in an electronic message to the pharmacy and/or the pharmacy's contracting agent filing the appeal within fifteen (15) days indicating its determination. If the appeal is determined to be valid, the maximum allowable cost for the drug shall be adjusted for the appealing pharmacy effective as of the date of the original claim for payment. The pharmacy benefit manager shall require the appealing pharmacy to reverse and rebill the claim in question in order to obtain the corrected reimbursement;
(4) If an update to the maximum allowable cost is warranted, the pharmacy benefit manager or insurer shall adjust the maximum allowable cost of the drug effective for all similarly situated pharmacies in its network in the state effective no later than one day after the date the appeal was determined to be valid; and
(5) If an appeal is denied, the pharmacy benefit manager shall provide the reason for the denial and identify the national drug code of a therapeutically equivalent drug, as determined by the federal Food and Drug Administration, that is available and in adequate supply for purchase by pharmacies in this state from wholesalers at a price which is equal to or less than the maximum allowable cost for that drug as determined by the pharmacy benefit manager.
27-29.1-10. Costs of enforcement.
The total cost of the enforcement under this chapter
(1) One hundred fifty percent (150%) of the total salaries and benefits paid to the personnel LC006502 - Page 4 of 8 of the
(2) All reasonable technology costs related to the enforcement process. Technology costs shall include the actual cost of software and hardware utilized in the enforcement process and the cost of training personnel in the proper use of the software or hardware;
(3) All necessary and reasonable education and training costs incurred by the state to maintain the proficiency and competence of the enforcing personnel. All these costs shall be incurred in accordance with the appropriate state of Rhode Island regulations, guidelines, and procedures
(4) Any reasonable expenses of any experts, consultants, and contractors retained by the health insurance commissioner; and
(5) Any and all funds collected from other enforcement actions from this title levied against pharmacy benefit managers determined by the health insurance commissioner to be surplus, shall be deposited into the health insurance market integrity fund restricted receipt account established pursuant to § 42-157.1-5.
27-29.1-11. Evaluation report.
The health insurance commissioner
SECTION 2. Chapter 27-29.1 of the General Laws entitled "Pharmacy Freedom of Choice — Fair Competition and Practices" are hereby amended by adding thereto the following sections:
27-29.1-12. Duty, accountability, and transparency of pharmacy benefit managers.
(a)(1) The pharmacy benefit manager shall have a duty and obligation to perform pharmacy benefit management services with care, skill, prudence, diligence, and professionalism.
(2) A pharmacy benefit manager interacting with a covered individual shall have the same duty to a covered individual as the insurer for whom it is performing pharmacy benefit management services.
(3) A pharmacy benefit manager shall have a duty of good faith and fair dealing with all parties including, but not limited to, covered individuals and pharmacies, with whom it interacts in the performance of pharmacy benefits management services.
(b) All funds received by the pharmacy benefit manager in relation to providing pharmacy benefit management services shall be received by the pharmacy benefit manager in trust and shall LC006502 - Page 5 of 8 be used or distributed only pursuant to the pharmacy benefit manager's contract with the insurer or applicable law; including any administrative fee or payment to the pharmacy benefit manager expressly provided for in the contract to compensate the pharmacy benefit manager for its services. Any funds received by the pharmacy benefit manager through spread pricing shall be subject to this section.
(c) Beginning August 1, 2027, a pharmacy benefit manager shall provide to an insurer for whom it is providing pharmacy benefit services:
(1) Any pricing discounts, rebates of any kind, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits received by the pharmacy benefit manager. The insurer shall have access to all financial and utilization information of the pharmacy benefit manager in relation to pharmacy benefit management services provided to the insurer;
(2) The terms and conditions of any contract or arrangement between the pharmacy benefit manager and any party relating to pharmacy benefit management services provided to the insurer including, but not limited to, dispensing fees paid to the pharmacies; and
(3) Any activity, policy, practice, contract or arrangement of the pharmacy benefit manager that directly or indirectly presents any conflict of interest with the pharmacy benefit manager's relationship with or obligation to the insurer.
(d) Beginning August 1, 2028, reports required to be provided under the Consolidated Appropriation Act of 2026, and subsequent regulations, shall be deemed sufficient to comply with the requirements of this subsection.
(e) Any information required to be disclosed by a pharmacy benefit manager to an insurer under this section that is reasonably designated by the pharmacy benefit manager as proprietary or trade secret information shall be kept confidential by the insurer, except as required or permitted by law, including disclosure necessary to prosecute or defend any legitimate legal claim or cause of action. Designation of information as proprietary or trade secret information under this subsection shall have no effect on the obligations of any pharmacy benefit manager or insurer to provide that information to the office of health insurance commissioner, provided any such information provided to the office of health insurance commissioner shall be confidential and exempt from disclosure under § 38-2-2.
27-29.1-13. Rules and regulations.
The health insurance commissioner shall promulgate rules and regulations necessary to effectuate the purpose of this chapter, including, defining, limiting, and relating to the duties, obligations, requirements and other provisions relating to pharmacy benefit managers. LC006502 - Page 6 of 8
SECTION 3. This act shall take effect on January 1, 2027.