AN ACT RELATING TO COMMERCIAL LAW -- GENERAL REGULATORY PROVISIONS -- DECEPTIVE TRADE PRACTICES (Provides that certain actions taken by pharmacy benefits managers are deceptive or unfair trade practices.)

H8360

2026 -- H 8360
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LC006206
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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 COMMERCIAL LAW -- GENERAL REGULATORY PROVISIONS --
DECEPTIVE TRADE PRACTICES

Introduced By:
Representatives Ackerman, Donovan, McNamara, Fellela, Edwards,
Slater, Potter, Newberry, and Corvese

Date Introduced:
March 27, 2026

Referred To:
House Corporations
(Attorney General)
It is enacted by the General Assembly as follows:
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SECTION 1. Chapter 6-13.1 of the General Laws entitled "Deceptive Trade Practices" is
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hereby amended by adding thereto the following section:
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6-13.1-31. Prohibited acts - Pharmacy benefits managers.

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(a) For the purposes of this section:
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(1) “Effective rate pricing” means any payment reduction for pharmacist or pharmacy
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services by a pharmacy benefits manager through reconciliation processes or aggregate payment
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reductions that are not expressly disclosed and agreed to between the pharmacy benefits manager
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and pharmacist or pharmacy and that result in reimbursement below the contracted rate.
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(2) “Enrollee” means an individual residing in this state for whom an insurer administers,
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provides, pays for, insures, or covers healthcare services; provided, however, that for purposes of
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this section, the term shall exclude individuals enrolled in Medicare Part D, the federal employee
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health benefit program, TRICARE, or the VA program.
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(3) “Inducement” means a financial incentive including, but not limited to, variations in
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premiums, deductibles, copayments, or coinsurance, offered to influence the selection,
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recommendation, or use of health care items or services.
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(4) “Maximum allowable cost price” or “MAC price” means the maximum amount that a
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pharmacy benefits manager will reimburse toward the cost of a drug.
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(5) “Patient steering” means any communication, verbal or written, by a pharmacy benefits

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manager to a patient to directly or indirectly influence the patient’s choice of pharmacy or
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encourage use of an alternate pharmacy that is a preferred pharmacy. This includes any requirement
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that a consumer utilize a particular pharmacy.
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(6) “Pharmacy benefits manager” or “PBM” means an entity doing business in this state
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that contracts to administer or manage prescription drug benefits on behalf of any carrier that
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provides prescription drug benefits to residents of this state.
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(7) “Spread pricing” means the model of prescription drug pricing in which a pharmacy
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benefits manager charges a health benefit plan a contracted price for prescription drugs that differs
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from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or
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pharmacy for pharmacy goods or services.
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(b) Violations. It shall be an unfair and deceptive trade practice and a method of unfair
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competition in violation of this chapter for any pharmacy benefits manager to:
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(1) Conduct or participate in spread pricing or effective rate pricing;
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(2) Directly or indirectly engage in patient steering to a pharmacy in which the pharmacy
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benefits manager, or any of its affiliated entities, maintains an ownership interest or control;
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(3) Penalize an enrollee or offer an inducement to an enrollee for the purpose of
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encouraging use of a specific retail, mail-order, or other pharmacy in which a pharmacy benefits
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manager holds an ownership or controlling interest, or in which the pharmacy holds an ownership
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or controlling interest in the pharmacy benefits manager;
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(4) Require a pharmacist or pharmacy to purchase drugs from a particular wholesaler;
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(5) Deflate or fail to adjust the MAC price set by the pharmacy benefits manager where the
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wholesaler offering the price upon which the MAC price is based chooses not to sell the drug to
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the pharmacist or pharmacy, rendering the MAC price unavailable to the pharmacist or pharmacy;
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(6) Fail to honor maximum allowable cost requirements in accordance with §§ 27-18-33.2,
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27-19-26.2, 27-20-23.2, 27-20.1-15.1, or 27-41-38.2;
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(7) Impose an early-refill restriction on a maintenance medication with a prescription of at
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least a thirty (30) day supply that requires fewer than seven (7) days of medication remaining before
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the prescription may be refilled; provided, however, that pursuant to regulation, guidance or at the
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direction of the executive office of health and human services, a pharmacy benefits manager may
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apply a more restrictive early refill policy for Medicaid enrollees without violating the provisions
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of this subsection. This provision shall not apply to controlled substances in schedules II to V;
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(8) Fail to honor or otherwise delay the acceptance of previously completed step therapy
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documentation where the prescribed drug is on the health plan’s prescription drug formulary, the
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enrollee has tried the step therapy required while enrolled in their current health plan or a health

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plan in which they were previously enrolled, and the enrollee’s provider has submitted justification
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and supporting clinical documentation that such prescription drug was discontinued due to lack of
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efficacy or effectiveness, diminished effect, or an adverse effect or event;
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(9) Exploit prescription drug information obtained from enrollees for monetary gain or
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economic power over pharmacists or pharmacies including, but not limited to, using data mining
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or other similar methods to gather patient information generated or obtained throughout the
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prescription filling process at any pharmacy for the purpose of directing business toward a
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pharmacy commonly owned, controlled, or exclusively contracted with the PBM;
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(10) Sell, exchange, or use in any manner prescription drug information regarding an
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enrollee obtained from an enrollee’s use of a prescription drug for purposes of marketing
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solicitation, patient steering, generating referrals, or any other practice or act that provides the
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pharmacy benefits manager, or any of its affiliates or subsidiaries, economic power or control over
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pharmacists or pharmacies, or that interferes in the enrollee’s free choice of pharmacy;
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(11) Engage in drug repackaging for the purpose of extracting a price markup. A pharmacy
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benefits manager that owns or controls a mail-order pharmacy shall not allow the mail-order
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pharmacy to repackage drugs for the purpose of selling the repackaged items at prices higher than
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the reimbursement price of the drug in its original manufacturer packaging, unless the enrollee to
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whom the repackaged drugs are dispensed is informed in writing that the drug has been repackaged
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and is being sold at a higher price; or
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(12) Operate in Rhode Island without being registered and in good standing with the
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secretary of state to do business in the state or without being licensed and in good standing with the
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department of business regulation. Each day that a pharmacy benefits manager operates without
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such registration or licensure and good standing shall constitute a separate violation.
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(c) Construction.
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(1) Except where expressly provided, for purposes of this section, a violation shall be
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deemed to occur each time a prohibited act is committed for each individual consumer transaction.
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(2) Nothing in this section shall be construed to prohibit truthful, non-misleading
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communications regarding cost or interfere with, or violate, a consumer’s right to know where the
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consumer may obtain the lowest cost drugs, whether a consumer is utilizing insurance or other
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third-party reimbursement or not.
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(3) Nothing in this section shall be construed to interfere with the requirement that
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consumers receive notice of changes to pharmacy networks, such as the inclusion of new
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pharmacies or removal of existing pharmacies from networks.
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(4) Nothing in this section shall prohibit the authorized use of protected health information

LC006206 - Page 3 of 5
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for health care operations under the Health Insurance Portability and Accountability Act of 1996
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(Pub. L. No. 104-191).
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(5) Nothing in this section shall be construed or applied in a manner that conflicts with
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applicable federal law or regulation.
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(6) Nothing in this section shall be construed to limit or preclude the authority of the
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attorney general to pursue any other remedy, penalty, or cause of action available under common
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law or statute including, but not limited to, actions for injunctive relief, restitution, civil penalties,
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or other equitable or legal relief. Nor shall this section be construed to limit the application of
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chapter 13.1 of title 6 ("deceptive trade practices") or any other provision of the general laws to the
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conduct described herein. This amendment shall be interpreted to clarify existing law only.
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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 COMMERCIAL LAW -- GENERAL REGULATORY PROVISIONS --
DECEPTIVE TRADE PRACTICES
***
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This act would provide that certain actions taken by pharmacy benefits managers are to be
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considered deceptive or unfair trade practices.
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This act would take effect upon passage.
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