Requires prescription benefit managers to approve a specific medication prescribed by a doctor when supported by a notarized medical necessity letter and requires that any denial be reviewed and documented by a licensed medical expert.

Rhode Island Prescription Benefit Manager Accountability Act

This bill targets prescription benefit managers (PBMs) — the companies that act as middlemen between insurance plans and pharmacies, deciding which medications are covered and at what cost. Under this proposal, if a doctor prescribes a specific medication and provides a notarized letter explaining why that particular drug is medically necessary for their patient, the PBM would be required to approve coverage for that medication. In other words, a formal written statement from a doctor backing up their prescription would carry significant weight in getting a drug covered.

The bill also adds an oversight requirement for cases where a PBM still wants to deny coverage. Any such denial would have to be reviewed and documented by a licensed medical professional — meaning a qualified healthcare expert, not just an administrative employee, would need to evaluate and sign off on the decision to reject coverage. This is meant to ensure that coverage denials are based on legitimate medical judgment rather than purely administrative or cost-related reasons.

This legislation would most directly affect patients who have had difficulty getting their insurance to cover a medication their doctor specifically prescribed for them. It would also affect the PBMs themselves, requiring them to change how they handle these situations, and it could impact doctors who may need to take the extra step of providing a notarized letter to support their prescriptions. The bill has been introduced and sent to the House Health & Human Services Committee for further review.