Rhode IslandS30592026 Regular SessionSenateWALLET

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

Sponsored By: Robert Britto (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

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

Stronger protections at the pharmacy counter

The law bans PBM gag clauses. Your pharmacist can tell you the price, cheaper options, and cash deals. Your copay cannot be more than the pharmacy’s total charge. The pharmacy keeps the adjudicated amount, and the PBM cannot take it back. PBMs cannot change your prescription without your prescriber’s approval or clear legal authority. PBMs must treat you with the same duty as your insurer and act in good faith.

Fair generic pricing appeals for pharmacies

PBMs must run a clear appeal process for multi‑source generic prices. A pharmacy has 30 business days after the first claim to appeal. The PBM must acknowledge by email and decide within 7 business days. If the appeal is valid, the PBM fixes the price back to the claim date and the pharmacy can reverse and rebill. Similar Rhode Island pharmacies get the updated rate. If denied, the PBM must name a therapeutically equivalent drug that is available at or below the PBM’s price limit.

Stronger state oversight of PBM money

All money PBMs get for pharmacy services is held in trust and used only as contracts or law allow, including spread pricing funds. PBMs must give insurers written accounts at least yearly of rebates, discounts, clawbacks, fees, conflicts, and related financial and use data. PBMs may mark data as a trade secret, but insurers must still provide it when required, and regulators can access it. PBMs are regulated under the state insurance chapter, and the director can set PBM rules and limits on administrative fees.

Rules for pharmacy access and networks

The law defines key PBM and network terms, including spread pricing and who can bid to join a restricted network. Insurers that offer pharmacy benefits must show the state they can provide enough pharmacies, staff, access, and steady service in their area. These rules help keep in‑network pharmacy access clear and consistent for covered people.

PBMs and insurers pay enforcement costs

When the state enforces this law, the PBMs and insurers named in the complaint split the enforcement costs equally. Costs can include 150% of enforcement staff salaries and benefits (net of any reimbursements), reasonable tech costs, and training. Any surplus from other enforcement actions goes to the Health Insurance Market Integrity Fund.

Sponsors & Cosponsors

Sponsor

Robert Britto
Democratic • Senate

Cosponsors

Frank A. Ciccone, III
Democratic • Senate
Matthew L. LaMountain
Democratic • Senate
Valarie J. Lawson
Democratic • Senate
Melissa A. Murray
Democratic • Senate
David P. Tikoian
Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 146 • 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

Senate vote • 5/26/2026

RELATING TO INSURANCE -- FAIR COMPETITION AND PRACTICES Passage