Rhode Island 2026 Regular Session

Rhode Island House Bill H7947

Introduced
2/27/26  

Caption

Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2027.

Impact

The bill is expected to significantly affect how health insurance companies calculate enrollee contributions, potentially lowering these contributions for individuals who face considerable out-of-pocket costs associated with medications. By including third-party payments in the calculations, the bill aims to provide a more accurate and equitable assessment of the financial burden placed on individuals under their health insurance plans, thereby offering a degree of relief to enrollees facing high medication costs.

Summary

House Bill H7947 amends existing legislation related to insurance and prescription drug benefits, specifically addressing the calculation of an enrollee's overall contribution to out-of-pocket maximums and cost-sharing requirements. The bill mandates that insurers and pharmacy benefit managers include any amounts paid by the enrollee or on their behalf by a third party when determining these contributions. The provisions of this bill are set to take effect for health plans entered into, amended, extended, or renewed on or after January 1, 2027.

Contention

While the bill receives support for its intent to alleviate out-of-pocket costs, there may be contention regarding its implementation and effects on health plan pricing. Critics may raise concerns about the fiscal implications for insurers and whether these changes could lead to increased premiums as companies adjust their policies to accommodate the new requirements. Additionally, some stakeholders in the healthcare industry may argue about potential complexities in tracking and reporting the necessary information to comply with the new regulations.

Companion Bills

No companion bills found.

Previously Filed As

RI S0477

Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.

RI H6209

Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.

RI S0786

Prohibits prior authorization or a step therapy protocol for the prescription of a nonpreferred medication on their drug formulary used to assess or treat an enrollee's bipolar disorder, schizophrenia or schizotypal.

RI S0707

Creates the Rhode Island Individual Market Affordability Act of 2024 to help reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health insurance coverage through the Rhode Island health benefits exchange.

RI H5996

Creates the Rhode Island Individual Market Affordability Act of 2024 to help reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health insurance coverage through the Rhode Island health benefits exchange.

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 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 S0900

Includes manufactured homes on leased land under a long-term lease in excess of thirty (30) years at the time of enrollment within the classification of affordable housing.

RI H6163

Includes manufactured homes on leased land under a long-term lease in excess of thirty (30) years at the time of enrollment within the classification of affordable housing.

RI S0268

Requires every individual or group health insurance contract effective on or after January 1, 2026, to provide coverage to the insured and the insured's spouse and dependents for all FDA-approved contraceptive drugs, devices and other products.

Similar Bills

KS HB2551

Enacting the Kansas pharmacy services administrative organization act.

AR SB593

To Amend The Arkansas Pharmacy Benefits Manager Licensure Act; And To Create The Pharmacy Services Administrative Organization Act.

MS HB558

Pharmacy services; prohibit insurers and PBMs from requiring persons to obtain exclusively through pharmacies that they own.

MS HB1125

Pharmacy services; prohibit insurers and PBMs from requiring persons to obtain exclusively through pharmacies that they own.

NJ S2345

"Patient and Provider Protection Act."

AR SB475

To Establish The Pharmacy Services Administrative Organization Act; And To Regulate Pharmacy Services Administrative Organizations.

AZ HB2429

Pharmacy benefits; pharmacy management networks

AZ HB2813

Pharmacy benefits; workers' compensation