2023 -- S 0874

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LC001226

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE RHODE ISLAND HEALTH

CARE REFORM ACT OF 2004 -- HEALTH INSURANCE OVERSIGHT

     

     Introduced By: Senators Ujifusa, Miller, Acosta, DiMario, Valverde, Lauria, Mack,
Quezada, and Kallman

     Date Introduced: March 30, 2023

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 42-14.5 of the General Laws entitled "The Rhode Island Health Care

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Reform Act of 2004 — Health Insurance Oversight" is hereby amended by adding thereto the

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following section:

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     42-14.5-6. Enforcement by the attorney general.

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     (a) The attorney general shall hire and supervise an outside contractor with expertise in

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analyzing pharmacy benefit managers (PBMs) to analyze PBMs doing business in the state, in order

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to determine and report on the following:

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     (1) The costs PBMs impose directly and indirectly on consumers and insurers;

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     (2) The effects PBMs have on consumers’ ability to get medicines prescribed by healthcare

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providers;

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     (3) The effects of PBMs on health outcomes of consumers; and

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     (4) The effects of PBMs on the financial condition of and administrative burdens placed

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upon healthcare providers, including pharmacists and pharmacies.

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     (b) The analysis shall include a consideration of PBM practices, including, but not limited

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to:

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     (1) Spread pricing;

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     (2) Manufacturer rebates;

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     (3) Prior authorizations;

 

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     (4) Creating of formularies;

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     (5) Creating provider networks;

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     (6) Encouraging use of mail-order pharmacies, and PBM-affiliated pharmacies;

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     (7) Activities that otherwise affect costs of drugs for consumers, insurers, and taxpayers;

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and

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     (8) Amounts of reimbursements to providers.

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     (c) PBMs shall provide information necessary to conduct the analysis, as well as all legally

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required analyses, in a timely manner as requested by the attorney general or its representatives.

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Failure of a PBM to provide such information in a timely manner shall permit the state to seek

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penalties and suspend a PBM’s license to conduct business in the state.

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     (d) Attorney general staff and outside contractors working on the analysis shall not have

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relevant financial connections to PBMs or the outcomes of the analysis.

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     (e) The attorney general shall present, in a report, the results of the analysis to the public

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and the general assembly within six (6) months after the effective date of this section.

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     (f) The attorney general shall have the authority to pursue civil and criminal actions against

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PBMs to enforce state contractual obligations and applicable consumer protection laws.

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     (g) The general assembly shall appropriate adequate funding to undertake the analyses,

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reports, and studies set forth in this section.

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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 STATE AFFAIRS AND GOVERNMENT -- THE RHODE ISLAND HEALTH

CARE REFORM ACT OF 2004 -- HEALTH INSURANCE OVERSIGHT

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     This act would require the attorney general to contract and work with a third-party auditor

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to analyze the practices of pharmacy benefit managers doing business in the state.

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     This act would take effect upon passage.

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LC001226

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