AN ACT RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE -- FAIR COMPETITION AND PRACTICES (Prohibits pharmacy benefits managers from refusing to provide coverage for a prescription drug chosen for a patient by the patient’s healthcare provider.)

H7817

2026 -- H 7817
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LC005052
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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:
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. Section 27-29.1-1 of the General Laws in Chapter 27-29.1 entitled "Pharmacy
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Freedom of Choice — Fair Competition and Practices" is hereby amended to read as follows:
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27-29.1-1. Definitions.
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For purposes of this chapter, the following terms shall mean:
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(1) “Director” shall mean the director of the department of business regulation.
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(2) “Eligible bidder” shall mean a retail pharmacy, community pharmacy, or pharmacy
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department registered pursuant to chapter 19.1 of title 5, irrespective of corporate structure or
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number of locations at which it conducts business, located within the geographical service area of
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a carrier and willing to bid for participation in a restricted pharmacy network contract.
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(3) “Insured” shall mean any person who is entitled to have pharmacy services paid by an
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insurer pursuant to a policy, certificate, contract, or agreement of insurance or coverage.
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(4) “Insurer” shall mean an insurance carrier as defined in chapters 18, 19, 20, and 41 of
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this title.
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(5) “Nonrestricted pharmacy network” shall mean a network that permits any pharmacy to
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participate on substantially uniform terms and conditions established by an insurer or pharmacy
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benefits manager.
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(6) “Pharmacy benefits manager” shall mean any person or entity who or that is not
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licensed in Rhode Island as an insurer and that develops or manages pharmacy benefits, pharmacy

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network contracts, or the pharmacy benefit bid process.
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(7) “Prescriber” shall mean any healthcare professional licensed pursuant to the laws of
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this state and authorized to prescribe drugs to patients to treat or manage any condition of the body
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or mind.
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(7)
(8)
“Restricted pharmacy network” shall mean an arrangement for the provision of
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pharmaceutical drug services to insureds that under the terms of an insurer’s policy, certificate,
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contract, or agreement of insurance or coverage requires an insured or creates a financial incentive
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for an insured to obtain prescription drug services from one or more participating pharmacies that
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have entered into a specific contractual relationship with the carrier.
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SECTION 2. 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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27-29.1-7.1. Acceptance of prescriber’s-recommended drug.

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(a) A pharmacy benefits manager shall accept and honor a prescriber’s chosen prescription
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drug for a patient.
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(b) A pharmacy benefits manager is prohibited from substituting, denying, rejecting, or
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otherwise failing to authorize coverage for a prescription drug selected by a prescriber for a patient
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on the basis of the pharmacy benefits manager’s own clinical judgment, cost containment protocol,
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formulary preference, or step therapy requirement.
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(c) Any pharmacy benefits manager’s action that results in the denial, delay, or
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modification of a prescriber’s chosen drug for a patient shall be deemed an unlawful interference
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with the practice of medicine and shall be subject to penalties instituted by the director of the
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department of business regulation.
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(d) The director of the department of business regulation or the director’s designee shall
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promulgate rules, regulations, and penalties necessary to implement this chapter.
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SECTION 3. 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 prohibit pharmacy benefits managers from refusing to provide coverage for
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a prescription drug chosen for a patient by the patient’s healthcare provider.
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This act would take effect upon passage.
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LC005052
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