Bill > S0477

This bill modifies Rhode Island's health insurance regulations by requiring insurers and pharmacy benefit managers to include third-party payments and certain prescription drug costs when calculating an enrollee's out-of-pocket maximum or cost-sharing requirements. Specifically, the bill mandates that amounts paid by the enrollee or on their behalf shall be counted towards out-of-pocket maximums, particularly for prescription drugs without generic equivalents or those obtained through special circumstances like prior authorization, step therapy protocols, or appeal processes. The bill includes a provision to ensure that these calculations do not compromise Health Savings Account (HSA) eligibility under federal tax law, with specific rules for High Deductible Health Plans. These new requirements will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026. The bill also expands definitions of key terms in the health insurance regulatory framework, such as adding more precise descriptions of "cost sharing," "insurer," "person," and "pharmacy benefit manager" to provide clarity and comprehensiveness in the statute.

Health and Social Services

https://status.rilegislature.gov/