AN ACT RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION REVIEW ACT (Prohibits healthcare insurers from requiring or conducting a review for prescription medicine used to treat alcohol or opioid use disorder containing Methadone, Burenorphine, or Naltrexone, or approved to mitigate opioid withdrawal symptoms.)

H7187

2026 -- H 7187
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LC004118
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION
REVIEW ACT

Introduced By:
Representatives Edwards, Bennett, Potter, Carson, Fogarty, and Casimiro

Date Introduced:
January 21, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Chapter 27-18.9 of the General Laws entitled "Benefit Determination and
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Utilization Review Act" is hereby amended by adding thereto the following section:
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27-18.9-17. Utilization review decisions.

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(a) A utilization review decision shall not retrospectively deny coverage for healthcare
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services provided to a covered person, when prior approval has been obtained from the insurer or
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its designee for those services, unless the approval was based upon fraudulent, materially
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inaccurate, or misrepresented information submitted by the covered person, authorized person, or
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the provider.
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(b) For health benefit plans issued or renewed on or after January 1, 2027, an insurer shall
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not require or conduct a prospective or concurrent review for a prescription medicine:
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(1) That is used in the treatment of alcohol or opioid use disorder;
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(2) That contains Methadone, Buprenorphine or Naltrexone; or
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(3) That was approved before January 1, 2027, by the United States Food and Drug
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Administration for the mitigation of opioid withdrawal symptoms.
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(c) In conducting utilization reviews for Medicaid benefits, each Medicaid managed care
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organization shall use the medical necessity criteria selected by the Rhode Island division of
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insurance for making determinations of medical necessity and clinical appropriateness pursuant to
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the utilization review plan.

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SECTION 2. This act shall take effect upon passage.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION
REVIEW ACT
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This act would prohibit healthcare insurers from requiring or conducting a review for
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prescription medicine that is used in the treatment of alcohol or opioid use disorder, that contains
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Methadone, Burenorphine, or Naltrexone or that was approved for the mitigation of opioid
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withdrawal symptoms, commencing January 1, 2027.
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This act would take effect upon passage.
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