Rhode Island requires prescription benefit managers' approval starting January 2027

Prescription benefit managers must get the health insurance commissioner's approval to operate, offer services, or present themselves as such in Rhode Island. The requirement covers businesses that manage prescription benefits in Rhode Island. Applicants must provide business records and financial information for state review. Regular certificates last 24 months. Applications cost $10,000 per year or part of a year covered, and renewal costs $10,000. A provisional certificate costs $10,000. Certificate holders also pay their share of state oversight expenses. The law takes effect January 1, 2027. Provisional certificates can qualify businesses for up to two years after the commissioner issues application guidance.

Prescription benefit managers must report payments, contract terms, and business practices to the health insurance commissioner. Reports cover drugmaker payments kept by managers or passed to insurers and patients, pharmacy payment terms, and other financial dealings. Reports held by the commissioner remain confidential, except for combined public figures that protect confidential company information. Missing an annual report can bring a fine of up to $10,000 per day. This chapter replaces the separate reporting and study provision in Article 12, Section 13 of 2026 H 7127 Substitute A, as amended. These rules take effect January 1, 2027. Reports are due on or before July 1 each year, and combined figures must be published no later than October 1 each year.

The health insurance commissioner can order repayment and fines for violations and can suspend or revoke a manager's approval to operate. Repayment can cover losses suffered by anyone harmed by a manager's unlawful actions. Managers are responsible for violations by others performing prescription benefit services for them, even without their knowledge or approval. Suspension or revocation requires notice and a hearing. The commissioner can delay it for good cause to allow contract commitments to be met. A manager whose approval is revoked cannot obtain another certificate for at least one year. If a court reviews the revocation, that period starts when the court's final decision upholds it. These enforcement rules take effect January 1, 2027.