AN ACT RELATING TO FOOD AND DRUGS -- PRESCRIPTION BENEFIT MANAGER ACCOUNTABILITY ACT (Requires prescription benefit managers to approve a specific medication prescribed by a doctor when supported by a notarized medical necessity letter and requires that any denial be reviewed and documented by a licensed medical expert.)

H7814

2026 -- H 7814
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LC005681
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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 FOOD AND DRUGS -- PRESCRIPTION BENEFIT MANAGER
ACCOUNTABILITY ACT

Introduced By:
Representative Charlene Lima

Date Introduced:
February 26, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Title 21 of the General Laws entitled "FOOD AND DRUGS" is hereby
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amended by adding thereto the following chapter:
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CHAPTER 38
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PRESCRIPTION BENEFIT MANAGER ACCOUNTABILITY ACT
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21-38-1. Short title.

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This act shall be known and may be cited as "Prescription Benefit Manager Accountability
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Act".
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21-38-2. Definitions.

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(a) "Prescription benefit manager" or "PBM" means any person or entity that administers
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or manages prescription drug benefits on behalf of a health insurer, health plan, or other third party
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payer.
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(b) "Prescribing practitioner" means a physician or other health care provider licensed and
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authorized under the laws of this state to prescribe prescription medications.
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21-38-3. Mandatory fulfillment of prescribed medication.

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(a) Whenever a prescribing practitioner prescribes a specific medication for a patient, the
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prescription benefit manager or any entity responsible for processing or approving the prescription
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shall approve and authorize coverage of that specific medication as written if the prescribing
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practitioner submits a notarized letter stating:

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(1) The medical necessity for the specific medication prescribed; and
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(2) That alternative medications are not as effective or are not clinically appropriate for the
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patient.
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(b) Upon receipt of the notarized letter described in subsection (a) of this section, the
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prescription benefit manager shall not substitute, deny, or require step therapy for a different
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medication.
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21-38-4. Denial requirements and medical review.

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(a) Any denial of a prescribed medication shall be made only after review by a licensed
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health care professional with documented medical expertise in the specific medication or the
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medical condition for which it is prescribed.
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(b) The prescription benefit manager shall document, at the time of denial:
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(1) The name, license number, and specialty of the reviewing health care professional;
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(2) The relevant medical expertise; and
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(3) The clinical basis for the denial.
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(c) Such documentation shall be provided to the prescribing practitioner and the patient
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upon request.
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21-38-5. Enforcement.

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(a) Any violation of this chapter shall constitute an unfair or deceptive act or practice and
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may be enforced by the attorney general.
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(b) The department of health may promulgate rules and regulations necessary to implement
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this chapter.
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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 FOOD AND DRUGS -- PRESCRIPTION BENEFIT MANAGER
ACCOUNTABILITY ACT
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This act would require prescription benefit managers to approve a specific medication
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prescribed by a doctor when supported by a notarized medical necessity letter and require that any
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denial be reviewed and documented by a licensed medical expert.
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This act would take effect upon passage.
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LC005681 - Page 3 of 3