Rhode Island 2026 Regular Session

Rhode Island House Bill H7692

Introduced
2/11/26  

Caption

Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).

Impact

If passed, H7692 will significantly amend Chapter 42-7.2 of the General Laws related to the Office of Health and Human Services. It could lead to a more standardized approach to managing pharmacy benefits in Medicaid, potentially improving patient outcomes and reducing unnecessary expenditures. The bill's compliance requirements will enforce stricter operating standards on PBMs, compelling them to operate in a manner that is more aligned with the needs of the patients they serve and decreasing the administrative burdens they impose on healthcare providers.

Summary

House Bill 7692 aims to regulate pharmacy benefit managers (PBMs) in Rhode Island by instituting transparency and accountability measures intended to control prescription drug costs for the state's Medicaid program. The bill requires PBMs to cease practices that increase costs, such as spread pricing, and mandates the elimination of barriers that prevent access to medically necessary treatments. It also directs the Secretary of the Executive Office of Health and Human Services (EOHHS) to establish rules for the performance and oversight of PBMs, ensuring that they operate with the best interests of Medicaid recipients in mind.

Contention

There have been discussions regarding the implications of such regulations on the pharmacy market in Rhode Island. While proponents argue that H7692 will ultimately lead to lower drug costs and better access to necessary medications for Medicaid recipients, opponents highlight concerns around the potential for reduced competition and implications for pharmacies. Notably, the discussions hint at a need for a balanced approach that considers both cost control and the viability of independent pharmacies in the state.

Companion Bills

No companion bills found.

Previously Filed As

RI H5463

Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).

RI S0117

Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).

RI S0221

Provides certain controls over prescription drug costs by imposing transparency, oversight and accountability requirements on commercial insurers and their pharmacy benefit managers.

RI H5429

Provides certain controls over prescription drug costs by imposing transparency, oversight and accountability requirements on commercial insurers and their pharmacy benefit managers.

RI H5254

Requires pharmacy benefit managers to reimburse pharmacist no less than national drug acquisition costs plus fee.

RI S0222

Requires pharmacy benefit managers to reimburse pharmacist no less than national drug acquisition costs plus fee.

RI S0173

Requires the secretary of the executive office of health and human services to monitor and mandate changes to the price-setting practices of pharmacy benefit managers to prohibit the spread pricing payment model.

RI H5498

Requires the secretary of the executive office of health and human services to monitor and mandate changes to the price-setting practices of pharmacy benefit managers to prohibit the spread pricing payment model.

RI S0013

Promotes transparency and accountability in the use of artificial intelligence by health insurers to manage coverage and claims.

RI H5172

Would promote transparency and accountability in the use of artificial intelligence by health insurers to manage coverage and claims.

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