RI H7692

Requires pharmacy benefit managers (PBMs) working with Rhode Island Medicaid to cease spread pricing and instead use pass-through pricing, where PBMs charge health plans the same amount they reimburse pharmacies and retain only a pre-determined administrative fee.

Prohibits PBMs from discriminatory treatment of non-affiliated pharmacies and from using utilization management processes (prior authorizations, step therapy, non-medical drug switching) that delay or prevent medically necessary care.

Mandates that enrollees receive benefits from manufacturer discounts and rebates provided to PBMs, and requires PBMs to provide enforcement documents to the Executive Office of Health and Human Services (EOHHS).

Requires EOHHS to analyze and recommend to the governor and general assembly by January 1, 2027 whether to create a single Medicaid PBM, carve out pharmacy benefits from managed care, adopt a uniform preferred drug list, or move to a Connecticut-style Medicaid program.

Authorizes EOHHS to impose civil fines up to $10,000 per violation for non-compliance and takes effect upon passage.