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Rhode IslandH85822026 Regular SessionHouseWALLET

AN ACT RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE--FAIR COMPETITION AND PRACTICES .

Sponsored By: Justine A. Caldwell (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 0 costs, 1 mixed.

Insurers must ensure pharmacy access

Beginning January 1, 2027, insurers must show the state they have enough pharmacies, staff, and facilities to serve members. They must ensure reasonable access and continuity of pharmacy service for people covered in Rhode Island.

Lower copays and open price talks

Beginning January 1, 2027, your copay at the pharmacy cannot be more than what the pharmacy charges. If you pay a copay, the pharmacy keeps the adjudicated amount, and the PBM cannot take it back. Pharmacists are free to tell you the cash price, their reimbursement, and cheaper, equivalent options. PBMs cannot change your prescribed drug without your prescriber’s approval unless a law or rule clearly allows it.

Stronger PBM transparency and duties

From January 1, 2027, PBMs must hold all drug‑benefit funds in trust, including spread pricing, and act in good faith to covered people. From August 1, 2027, PBMs must disclose rebates, fees, contracts, dispensing fees, and conflicts to insurers. Insurers keep PBM trade secrets confidential; the state gets the data and keeps it confidential. Starting August 1, 2028, federal PBM reports can meet these disclosure rules. The law defines spread pricing as charging more than the PBM paid the pharmacy.

Stronger oversight and shared enforcement costs

Starting January 1, 2027, Rhode Island regulates PBMs under chapter 84, and the health insurance commissioner issues rules to enforce it. PBMs and insurers under investigation must split enforcement costs equally. Covered costs include 150% of staff salaries and benefits, plus technology, training, and expert fees. Surplus collections go into the Health Insurance Market Integrity Fund.

Faster fixes to generic prices

Starting January 1, 2027, PBMs must keep a clear appeal process for generic drug prices. Pharmacies have 15 days to appeal and get an email receipt. PBMs must answer in 15 days. If the appeal is valid, prices are fixed back to the original claim, and pharmacies reverse and rebill. The PBM must update the price for similar pharmacies statewide by the next day. If denied, the PBM must explain why and list an equivalent drug’s NDC that wholesalers have at or below the MAC.

Sponsors & Cosponsors

Sponsor

  • Justine A. Caldwell

    Democratic • House

Cosponsors

  • Joseph J. Solomon, Jr.

    Democratic • House

Roll Call Votes

All Roll Calls

Yes: 108 • No: 0

Senate vote • 6/11/2026

RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE In Concurrence

Yes: 38 • No: 0

House vote • 6/10/2026

INS./PHARMACY FREEDOM OF CHOICE PASSAGE

Yes: 70 • No: 0

Actions Timeline

  1. Signed by Governor — Chapter 368

    6/22/2026Governor

  2. Transmitted to Governor

    6/18/2026Governor

  3. Senate passed Sub A in concurrence

    6/11/2026Senate

  4. Placed on Senate Calendar (06/11/2026)

    6/10/2026Senate

  5. House passed Sub A

    6/10/2026House

  6. Placed on House Calendar (06/10/2026)

    6/9/2026House

  7. Committee recommends passage of Sub A

    6/4/2026

  8. Proposed Substitute

    6/2/2026

  9. Scheduled for consideration (06/04/2026)

    6/2/2026

  10. Committee recommended measure be held for further study

    5/28/2026

  11. Scheduled for hearing and/or consideration (05/28/2026)

    5/26/2026

  12. Introduced, referred to House Health & Human Services

    5/26/2026House

Bill Text

  • H8582 - As Introduced

    5/26/2026

    HTMLPDF

  • H8582 - Substitute

    5/26/2026

    HTMLPDF

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