Prohibits pharmacy benefits managers from refusing to provide coverage for a prescription drug chosen for a patient by the patient’s healthcare provider.

Rhode Island Pharmacy Freedom of Choice Bill

This bill would limit the power of pharmacy benefits managers (PBMs) — the middleman companies that manage prescription drug benefits on behalf of health insurance plans — to deny coverage for medications that a patient's doctor or other healthcare provider has specifically chosen for them. In simple terms, if your doctor prescribes you a particular drug, the PBM handling your insurance plan would not be allowed to refuse to cover it.

Currently, PBMs can sometimes override a doctor's prescription decision by only covering certain drugs on their approved lists, known as "formularies," which can force patients to switch to different medications than what their provider recommended. This bill would require PBMs to cover whatever drug a healthcare provider determines is the right treatment for their patient, giving doctors and other providers more authority over treatment decisions.

This bill would primarily affect Rhode Islanders who rely on prescription medications and have health insurance that uses a PBM to manage drug benefits — which describes a large portion of people with employer-sponsored insurance or other private health plans. It would also affect the healthcare providers who prescribe medications, giving them greater confidence that their treatment decisions will be honored. PBMs and insurance companies would face new restrictions on their ability to manage which drugs they cover.

The bill has been introduced and referred to the House Health & Human Services Committee, where it will be reviewed before any further legislative action takes place.