Bill > H5498

This bill requires the secretary of the Executive Office of Health and Human Services (EOHHS) to monitor and mandate changes to the pricing practices of pharmacy benefit managers (PBMs) in the Rhode Island Medicaid program. Specifically, the bill aims to prohibit the "spread pricing" payment model, which is a practice where PBMs charge health plans more for prescription drugs than they reimburse pharmacies, keeping the difference as profit. The legislation seeks to ensure that PBMs and managed care organizations (MCOs) are transparent, do not increase unnecessary costs for the Medicaid program or patients, and demonstrate improvements in patient health outcomes. By adding a new provision to the secretary's duties, the bill requires that PBM contracts explicitly cease and prohibit spread pricing, with the intent of protecting Rhode Island residents and the state Medicaid program from high prescription drug costs. The act would take effect immediately upon passage, giving the EOHHS secretary the authority to implement these new requirements in PBM contract negotiations.

Health and Social Services

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