Rhode Island requires permission for prescription benefit managers starting in 2027

Prescription benefit managers must obtain a state certificate, meaning permission to operate, from Rhode Island’s health insurance commissioner. The law covers prescription benefit managers operating in Rhode Island, including companies managing prescription drug benefits for health insurers. Temporary certificates are allowed for up to two years after the commissioner issues application guidance. Full applications cost $10,000 per year or part of a year covered. Temporary applications and two-year renewals each cost $10,000. Certificate holders must also pay a share of the commissioner’s costs to oversee them. The law takes effect January 1, 2027. Full certificates expire 24 months after issue.

Prescription benefit managers must report drug discounts, payments, contract terms, and business practices to the health insurance commissioner. Reports include drugmaker discounts kept by managers or passed to insurers and patients. The commissioner may require more frequent reports. The commissioner must publish combined figures without revealing managers’ or insurers’ confidential information. Reports held by the commissioner remain confidential except for the combined public figures. This protection does not apply to records held by others. This chapter supersedes Article 12, Section 13 of 2026–H 7127 Substitute A, as amended, concerning pharmacy benefit manager reporting and a study. Annual reports are due on or before July 1. The commissioner must publish combined figures no later than October 1 each year.

The health insurance commissioner may order payments to people harmed by violations, impose fines, and suspend or revoke a manager’s permission to operate. Managers are responsible for covered violations by contractors and related companies performing benefit services, even without knowing about or approving their conduct. Suspending or revoking a full certificate requires notice and a hearing. Temporary certificates may be revoked for any reason with at least 60 days’ notice. Late annual reports may bring fines of up to $10,000 per day. Revocation generally bars managers and covered leaders from getting another certificate for at least one year. Leaders found personally blameless may be exempt. These enforcement rules take effect January 1, 2027.