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HB 8582

AN ACT RELATING TO INSURANCE -- PHARMACY FREEDOM OF CHOICE--FAIR COMPETITION AND PRACTICES

2026 Regular Session Introduced by Justine Caldwell and 1 co-sponsor

Rhode Island HB 8582 tightens PBM oversight to curb anti-competitive practices, enforce price transparency, fair copays, and mandatory disclosures to regulators and insurers.

06/22/2026 Signed by Governor
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WeVote Research Nonpartisan
Bill Summary · HB 8582

Summary of HB 8582 (Rhode Island, 2026)

Purpose and intent

  • This act, titled “Pharmacy Freedom of Choice — Fair Competition and Practices,” aims to regulate and increase transparency in pharmacy benefit management (PBM) within Rhode Island’s insurance framework.
  • It sets duties for PBMs, establishes accountability and disclosure requirements, and provides a framework for regulator oversight to protect insured individuals and pharmacies.

Key provisions and changes

  • Definitions (27-29.1-1)

    • Clarifies terms used in the chapter, including:
    • Eligible bidder: retail/community/pharmacy departments willing to bid in a restricted network.
    • Nonrestricted vs. restricted pharmacy networks.
    • PBM: entities that manage or administer pharmacy benefits (not licensed as insurers).
    • Spread pricing: amounts charged by a PBM exceeding amounts paid to pharmacies.

  • Availability and accessibility (27-29.1-2)

    • Insurers must demonstrate to the Director (Division of Business Regulation/Health Insurance Commissioner) their ability to ensure pharmacy services are available and accessible, with adequate personnel and facilities.

  • Regulation of PBMs (27-29.1-7)

    • PBMs are treated as third-party administrators under Rhode Island law and must file annual reports with the Department of Business Regulation, including:
    • Detailed financial arrangements with insurers.
    • Organization charts for affiliated entities if applicable.
    • PBMs may not substitute drugs or alter prescription terms without prescriber approval or lawful directive.
    • Prohibits PBMs from penalizing pharmacists for disclosing drug costs, cash prices, or alternative options.
    • Prohibits charging copayments that exceed the actual costs paid to the pharmacy; pharmacies must keep adjudicated costs when a copay is collected.
    • Requires a formal, fair process for multi-source generic drug pricing disputes, including:
    • A 15-day appeal window.
    • Clear contact information for filing appeals.
    • Timely electronic acknowledgment and determination.
    • If valid, adjust the maximum allowable cost (MAC) for the drug retroactively and rebill the pharmacy.
    • If warranted, MAC updates apply to all similarly situated pharmacies in the state within a short timeframe.
    • If denied, PBM/insurer must point to a federally designated therapeutically equivalent drug available at or below MAC.

  • Costs of enforcement (27-29.1-10)

    • Enforcement costs are borne by PBMs and/or insurers being investigated, on an equal basis.
    • Includes: 150% of applicable personnel salaries, technology costs, training, expert/consultant expenses, and potential surplus funds deposited into the Health Insurance Market Integrity Fund.

  • Evaluation report (27-29.1-11)

    • The Health Insurance Commissioner must study the impact of nonrestricted PBN practices on Rhode Island health insurance costs and report to the Joint Committee on Health Care Oversight by May 1, 2005, with recommendations due to the General Assembly by March 31, 2027.
    • Note: The 2005 date appears to be a drafting artifact; the act is set to address ongoing evaluation with a 2027 recommendation date.

  • Duty, accountability, and transparency of PBMs (27-29.1-12)

    • PBMs must perform PBM services with care, skill, prudence, and professionalism.
    • PBMs owe duties to covered individuals and insurers and must act in good faith and fair dealing.
    • All funds received by PBMs in relation to PBM services must be held in trust and used only per contracts or law; spread pricing proceeds fall under this provision.

  • Financial and information disclosures (27-29.1-12)

    • Beginning August 1, 2027:
    • PBMs must disclose to insurers all pricing discounts, rebates, inflation payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits.
    • Insurers gain access to all financial and utilization information related to PBM services.
    • PBMs must disclose contract terms, including dispensing fees and any arrangements that present conflicts of interest.
    • Beginning August 1, 2028, disclosures required under the state’s Consolidated Appropriation Act provisions will be deemed sufficient for these requirements.
    • Proprietary or trade secret information disclosed to insurers must be kept confidential by the insurer, with confidentiality maintained, but information must still be disclosed to the Health Insurance Commissioner as required by law.

  • Rules and regulations (27-29.1-13)

    • The Health Insurance Commissioner is authorized to promulgate rules necessary to enforce PBM duties, obligations, and related provisions.

  • Effective date

    • The act takes effect January 1, 2027.

Who is affected

  • Pharmacy Benefit Managers (PBMs): Subject to new duties, reporting, disclosure, and transparency requirements; restricted use of spread pricing; enhanced oversight and accountability.
  • Insurers and health plans: Must work with PBMs within new transparency and reporting framework; gain access to pricing, contract terms, and conflict-of-interest disclosures starting in 2027-2028.
  • Pharmacies (including retail, community, and hospital/pharmacy departments): Protected in terms of price transparency, copay integrity, and dispute resolution processes; eligible to appeal MAC pricing and seek fair reimbursement.
  • Covered individuals (patients): Benefit from increased transparency around drug pricing, cost-sharing, and available therapeutically equivalent alternatives.

Procedural and timeline notes

  • Effective date: January 1, 2027.
  • August 1, 2027: Start of mandatory disclosures to insurers (pricing, rebates, contract terms, conflicts of interest).
  • August 1, 2028: Compliance alignment with Consolidated Appropriation Act-required disclosures deemed sufficient.
  • Enforcement costs: Allocated to the parties under enforcement actions; funds may be deposited into the Health Insurance Market Integrity Fund if surplus funds exist.
  • The bill was introduced May 26, 2026, and referred to House Health & Human Services with a hearing scheduled for May 28, 2026.

Bottom-line impact

  • Aims to curb anti-competitive PBM practices, enhance price transparency, protect pharmacists and patients from unfavorable pricing dynamics, and strengthen regulatory oversight of PBMs within Rhode Island’s insurance landscape.
  • Introduces formal dispute resolution for multi-source generic pricing, tighter copayment rules, and comprehensive reporting requirements to the state regulators.

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

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