RI H7189

Pharmacy benefit managers (PBMs) must reimburse non-affiliated pharmacies at rates equal to or greater than what they pay their own affiliated pharmacies for the same drugs or services, including all fees, adjustments, and incentives

PBMs are prohibited from using contractual terms, performance metrics, or reimbursement methodologies that effectively pay non-affiliated pharmacies less than affiliated ones

Medicaid managed care organizations and their contracted PBMs must comply with these reimbursement parity requirements for all Medicaid pharmacy benefits

The Office of the Health Insurance Commissioner (OHIC) can request reimbursement data from PBMs to verify compliance, and enforcement authority lies with OHIC and the Attorney General

PBMs, insurers, and Medicaid managed care organizations cannot evade compliance through affiliation structures, subcontracting, or other contractual arrangements designed to favor affiliated pharmacies