WeVote
Log In

Bill

Bill

HB 8579

AN ACT RELATING TO INSURANCE -- PHARMACY BENEFIT MANAGERS ACT

2026 Regular Session Introduced by Susan Donovan and 1 co-sponsor

Rhode Island would require PBMs to obtain a state certificate of authority, endure ongoing supervision, and disclose pricing, contracts, and consumer protections to improve transpa

06/22/2026 Signed by Governor
0
WeVote Research Nonpartisan
Bill Summary · HB 8579

Overview

HB 8579, introduced in Rhode Island's 2026 session, would create a new regulatory framework for pharmacy benefit managers (PBMs) under a dedicated chapter of the Rhode Island Insurance statute. The bill would require PBMs to obtain a state certificate of authority, authorize ongoing supervision by the Health Insurance Commissioner, establish reporting and transparency obligations, and set grounds for suspension or revocation of a PBM’s authority. The act would take effect January 1, 2027.

Purpose and intent

  • Establish a formal regulatory structure for PBMs operating in Rhode Island.
  • Improve oversight over PBM practices, pricing, rebates, and network contracts.
  • Enhance transparency to insurers, employers, and covered individuals, with the goal of protecting consumers and ensuring fair competition.

Key provisions and changes

  • Chapter creation: Adds Chapter 84 (Pharmacy Benefit Managers Act) to Title 27 (Insurance).
  • Definitions: Clarifies terms including controlling person, PBM, insured/covered individual, rebates, spread pricing, restricted network, and PBM services.
  • Certificate of authority (COA):
    • No entity may act as a PBM in Rhode Island without a COA from the Health Insurance Commissioner.
    • Violations carry restitution/compensatory damages plus penalties (up to $10,000 for first violation, $15,000 for subsequent, or aggregate gross receipts, whichever is greater).
  • Application requirements for COA:
    • Submission from PBMs detailing corporate structure, leadership, finances, business plan, and internal controls.
    • Information on networks, pricing models, consumer protection practices, and potential conflicts of interest.
    • Disclosure of contracts with insurers and third-party administrations, and other state-specific and cross-state information.
    • Agreement to provide contracts for inspection by the Commissioner.
    • Obligation to notify the Commissioner of ownership/control changes; address updates within 30 days.
  • COA term, renewal, and fees:
    • Initial COA fee: $10,000 per year (or fraction).
    • COA valid for 24 months; renewals require a $10,000 renewal fee.
    • Automatic continuation of a renewal if filed timely; possible suspension/denial after due procedures.
  • Reporting requirements (annual):
    • By July 1 each year, PBMs must report: pricing rebates and other financial terms; contract terms with parties; patient utilization data (rebates/fees from manufacturers passed to insurers, to consumers, retained by PBM); standard practice responses (spread pricing, networks, utilization management); rebates by contract; and payments for ancillary services.
    • Commissioner may require quarterly or other statements.
    • Penalties up to $10,000 per day for failure to report; annual data publication of aggregated information (without disclosing proprietary details) by Oct. 1.
    • Confidentiality provisions to protect non-aggregate data.
  • Additional obligations:
    • PBMs and subcontractors must comply with applicable state law; responsibility for actions of affiliates/subcontractors.
  • Grounds for suspension or revocation:
    • Violations of laws/regulations, misrepresentation, fraud, incompetence, untrustworthiness, financial irresponsibility, misappropriation, prior bad conduct in other jurisdictions, tax noncompliance, or failure to meet COA requirements.
    • Notice-and-hearing requirements; potential delays to protect ongoing contractual obligations.
    • Post-revocation restrictions on re-entry for a defined period (at least one year).
  • Penalties and enforcement:
    • Civil penalties for violations; restitution and damages as ordered by the Commissioner.
    • Penalties and enforcement may continue even if a COA is surrendered or lapses.
  • Funds and regulatory framework:
    • Penalties deposited into the Health Insurance Market Integrity Fund.
    • Assessments on COA holders to cover the Commissioner’s operating expenses.
    • Rules and regulations to be promulgated by the Commissioner to implement the act.

Who/what is affected

  • PBMs operating in Rhode Island or seeking to operate; entities must obtain COA and comply with ongoing oversight.
  • Insurers, third-party administrators, employers, and covered individuals who interact with PBMs (via pricing, rebates, networks, and claims processing).
  • State regulators (Health Insurance Commissioner) who will supervise registrations, reporting, investigations, and enforcement.
  • Vendors and contractors engaged by PBMs, which are subject to the same compliance standards.

Procedural and timeline notes

  • Effective date: January 1, 2027.
  • Initial COA application and $10,000 annual fee required to begin operation.
  • COA expirations occur 24 months after issue; renewals require another $10,000 fee.
  • Annual reporting due by July 1; data published by October 1 (aggregated, non-confidential).
  • Penalty provisions include daily fines for noncompliance and permit revocation/suspension procedures with due process (Chapter 42, Chapter 35 references for administrative procedures).

This bill seeks to increase transparency, accountability, and consumer protection in PBM practices within Rhode Island.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.