Bill > S0173

This bill requires the secretary of the Executive Office of Health and Human Services (EOHHS) to monitor and mandate changes to the price-setting practices of pharmacy benefit managers (PBMs) in Rhode Island's Medicaid program, specifically targeting the spread pricing payment model. Spread pricing is a practice where PBMs charge health plans more for prescription drugs than they reimburse pharmacies, keeping the difference as profit. The legislation aims to increase transparency and reduce unnecessary costs in the Medicaid program by prohibiting this practice. The bill adds a new provision to the secretary's duties, requiring that contracts with managed care organizations (MCOs) ensure PBMs cease spread pricing activities and demonstrate improvement in patient health outcomes. This change is part of a broader effort to protect Rhode Island residents and the state Medicaid program from high prescription drug costs by increasing accountability and oversight of PBMs. The bill will take effect immediately upon passage, giving the EOHHS secretary the authority to implement these new requirements in Medicaid program contracts.

Health and Social Services

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