AN ACT RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE -- FAIR COMPETITION AND PRACTICES (Provides for fair pharmacy reimbursement from a pharmacy benefit manager, and also provides anti-discrimination prohibitions in regard to non-affiliated pharmacies or pharmacists.)

H7189

2026 -- H 7189
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LC003517
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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 -- PHARMACY FREEDOM OF CHOICE -- FAIR
COMPETITION AND PRACTICES

Introduced By:
Representatives Kislak, Fogarty, McGaw, Boylan, Speakman, Donovan,
Spears, and Handy

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 27-29.1 of the General Laws entitled "Pharmacy Freedom of Choice
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— Fair Competition and Practices" is hereby amended by adding thereto the following section:
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27-29.1-12. Fair pharmacy reimbursement and anti-discrimination.

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(a) Reimbursement parity.
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A pharmacy benefit manager shall not reimburse a non-affiliated pharmacy or pharmacist
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in an amount less than the net effective reimbursement, inclusive of all fees, adjustments,
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incentives, and other remuneration, paid directly or indirectly to an affiliated pharmacy or
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pharmacist for the same drug or service.
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(b) Anti-discrimination.
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A pharmacy benefit manager shall not impose contractual terms, reimbursement
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methodologies, performance metrics, or other requirements that have the effect of reimbursing non-
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affiliated pharmacies or pharmacists at a lower rate than affiliated pharmacies or pharmacists for
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the same drug or service.
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(c) Transparency of affiliated reimbursement.
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Upon request by the office of the health insurance commissioner (“OHIC”), a pharmacy
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benefit manager shall provide reimbursement data reasonably necessary to verify compliance with
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this section, including data relating to affiliated pharmacies.
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(d) Enforcement.

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This section shall be enforced by OHIC and the attorney general pursuant to their existing
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authority under law.
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(e) Medicaid applicability.
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All Medicaid managed care organizations, and all pharmacy benefit managers contracted
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by or on behalf of Medicaid managed care organizations, shall comply with the provisions of this
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section with respect to all Medicaid pharmacy benefits, whether administered directly or through a
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pharmacy benefit manager.
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(f) Prohibition on evasion.
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A pharmacy benefit manager, insurer, or Medicaid managed care organization shall not
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avoid compliance with this section through affiliation structures, subcontracting, differential
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pricing metrics, reimbursement methodologies, or contractual arrangements designed to favor
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affiliated pharmacies or pharmacists.
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(g) Rulemaking.
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The OHIC may promulgate and adopt rules and regulations necessary to implement and
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enforce this section.
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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 -- PHARMACY FREEDOM OF CHOICE -- FAIR
COMPETITION AND PRACTICES
***
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This act would require fair pharmacy reimbursement from a pharmacy benefit manager to
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a non-affiliated pharmacy or pharmacist and also provide anti-discrimination prohibitions by
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pharmacy benefit managers in regard to non-affiliated pharmacies or pharmacists.
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This act would take effect upon passage.
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LC003517
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