RI H7814

Prescription benefit managers (PBMs) must approve coverage for a specific medication as prescribed when the prescribing practitioner submits a notarized letter certifying medical necessity and that alternatives are not effective or clinically appropriate for the patient

PBMs are prohibited from substituting, denying, or requiring step therapy for a different medication once they receive the required notarized letter from the prescriber

Any denial of a prescribed medication must be reviewed by a licensed health care professional with documented expertise in the specific medication or medical condition being treated

PBMs must document the name, license number, specialty, relevant expertise, and clinical basis for any denial, and provide this documentation to the prescriber and patient upon request

Violations constitute unfair or deceptive acts enforceable by the Attorney General, with the Department of Health authorized to promulgate implementing regulations