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HB 5463

AN ACT RELATING TO STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND HUMAN SERVICES

2025 Regular Session Introduced by Megan Cotter and 6 co-sponsors

HB 5463 aims to curb high drug costs by boosting PBM transparency and expanding EOHHS oversight of Medicaid policy, reporting, and coordination.

04/30/2025 Committee recommended measure be held for further study
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Bill Summary · HB 5463

Summary — HB 5463

Title: AN ACT RELATING TO STATE AFFAIRS AND GOVERNMENT — OFFICE OF HEALTH AND HUMAN SERVICES
Bill #: HB 5463 (2025) — Companion: SB 1164
Introduced: Feb 12 / Mar 14, 2025 (filed)
Current status: 04/30/2025 — Committee recommended measure be held for further study

Main purpose / intent

The bill’s stated intent is to protect Rhode Islanders and the state Medicaid program from high prescription drug costs by requiring greater pharmacy benefit manager (PBM) transparency and accountability. To achieve that goal, HB 5463 modifies the statutory duties of the Secretary of the Executive Office of Health and Human Services (EOHHS), adding or clarifying responsibilities for oversight, coordination, reporting, and policy review related to Medicaid and state-administered health and human services.

Key provisions (summary of substantive changes)

Note: The printed portion of the amendment in the provided text focuses on revising Section 42-7.2-5 (Duties of the secretary). The bill:

  • States explicit intent to require greater PBM transparency and accountability as a policy objective.

  • Amends and restates the Secretary of EOHHS’s authority and duties to:

    • Serve as the governor’s chief advisor and liaison to federal policymakers on Medicaid reform.
    • Coordinate administration and financing of healthcare benefits and programs, including Medicaid section 1115 waiver activity and the Medicaid state plan under Title XIX.
    • Review and ensure coordination of Medicaid section 1115 waiver requests and state-plan amendments, assessing legal/fiscal soundness and feasibility of securing federal approvals.
    • Direct development and implementation of Medicaid policies, procedures, and systems (including integrated eligibility systems and coordination with HealthSource RI).
    • Conduct biennial comprehensive reviews of Medicaid eligibility criteria (beginning in 2015 per the statute’s timeline).
    • Implement service delivery reforms to improve integration, value, and health outcomes.
    • Prepare and submit an annual comprehensive Medicaid overview (by September 15 each year) to the governor, finance committee chairs, caseload estimating conference, and oversight committee. Required report elements include:
    • Expenditures under Titles XIX and XXI;
    • Expenditures, outcomes, and utilization rates by population/subpopulation served;
    • Expenditures/outcomes/utilization by state department or public entity receiving federal reimbursement;
    • Expenditures/outcomes/utilization by service type/provider;
    • Breakouts by mandatory vs. optional populations and services;
    • Information supporting federal Core Set quality measure reporting (children’s/adult/health home measures) to comply with the Bipartisan Budget Act of 2018.
    • Centralize and coordinate administrative functions (e.g., HR reforms, purchasing power, budgeting/finance/procurement, data management) to maximize resources and federal financial participation.
    • Require cooperation from department directors, local governments, and school departments in providing information/resources needed by the secretary.

  • The printed text is truncated; additional PBM-specific duties, enforcement mechanisms, reporting requirements, or penalties — if present — are not visible in the excerpt provided.

Who/what would be affected

  • Medicaid beneficiaries in Rhode Island (potentially through changes to pharmacy benefit administration and access).
  • Pharmacy Benefit Managers (PBMs), pharmacies, health plans, and prescription drug supply-chain participants (subject to any transparency/accountability measures in the full bill).
  • EOHHS and other state departments responsible for Medicaid and related services (increased reporting, coordination, and administrative obligations).
  • State budget and federal/state reimbursement processes (reporting and policy decisions could influence program costs and federal match strategies).

Procedural / timeline notes

  • Introduced and referred to House Finance (Feb–Mar 2025).
  • Read first time and referred to Judiciary & Civil Jurisprudence (04/07/2025).
  • Scheduled for hearing 04/25/2025; committee on 04/30/2025 recommended holding the measure for further study (committee action not to advance as of 04/30/2025).

Potential impact and considerations

  • If enacted, the bill would strengthen centralized oversight of Medicaid policy decisions and require transparent reporting that could enable more targeted cost-control efforts, including in prescription drug spending.
  • The practical effects on PBMs, drug prices, and Medicaid program costs depend on specific PBM-related provisions and enforcement mechanisms that are not visible in the truncated text. Additional language in the full bill could establish reporting requirements, auditing authority, contract terms, or restrictions that directly affect PBMs and pharmacy reimbursements.
  • Administrative burden on EOHHS and cooperating departments may increase due to expanded reporting and coordination duties; offsetting savings could result if transparency yields lower drug costs or better negotiated contracts.

Recommendation / next step

For stakeholders seeking specifics on PBM transparency measures and enforcement, review the full bill text (complete Section 42-7.2-5 amendments beyond the truncated excerpt) and companion SB 1164 to determine exact requirements, timelines, and any fiscal notes.

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

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