Rhode Island 2023 Regular Session

Rhode Island House Bill H5079 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- H 5079
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7	7	LC000173
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACEUTICAL COST
16	16	TRANSPARENCY
17	17	Introduced By: Representatives J Lombardi, Hull, Ajello, Kislak, Tanzi, and Felix
18	18	Date Introduced: January 12, 2023
19	19	Referred To: House Corporations
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Title 5 of the General Laws entitled "BUSINESSES AND PROFESSIONS" 1
24	24	is hereby amended by adding thereto the following chapter: 2
25	25	CHAPTER 19.3 3
26	26	PHARMACEUTICAL COST TRANSPARENCY 4
27	27	5-19.3-1. Pharmaceutical cost transparency -- Findings. 5
28	28	The general assembly hereby finds and declares as follows: 6
29	29	(1) The costs of prescription drugs have been increasing with regularity; 7
30	30	(2) Containing health care costs requires containing prescription drug costs; and 8
31	31	(3) In order to contain prescription drug costs, it is essential to understand the drivers of 9
32	32	those costs, as transparency is the first step toward cost containment. 10
33	33	5-19.3-2. Definitions. 11
34	34	As used in this chapter: 12
35	35	(1) "Board" means the state board of pharmacy created pursuant to § 5-19.1-3. 13
36	36	(2) "Department" means the Rhode Island department of health. 14
37	37	(3) "Manufacturer" means a person or entity licensed to manufacture legend drugs pursuant 15
38	38	to § 5-19.1-12. 16
39	39	(4) "Prescription drug" means a drug as defined in 21 U.S.C. § 321. 17
40	40	5-19.3-3. Identification of high cost prescription drugs. 18
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43	43	LC000173 - Page 2 of 6
44	44	(a)(1) The state board of pharmacy, in collaboration with the department, shall identify 1
45	45	annually up to fifteen (15) prescription drugs on which the state spends significant health care 2
46	46	dollars and for which the wholesale acquisition cost has increased by fifty percent (50%) or more 3
47	47	over the past five (5) years or by fifteen percent (15%) or more over the past twelve (12) months, 4
48	48	creating a substantial public interest in understanding the development of the drugs' pricing. The 5
49	49	drugs identified shall represent different drug classes. 6
50	50	(2) The board shall provide to the office of the attorney general the list of prescription drugs 7
51	51	developed pursuant to this subsection and the percentage of the wholesale acquisition cost increase 8
52	52	for each drug and shall make the information available to the public on the board's website. 9
53	53	(b)(1) For each prescription drug identified pursuant to subsection (a) of this section, the 10
54	54	office of the attorney general shall require the drug's manufacturer to provide a justification for the 11
55	55	increase in the wholesale acquisition cost of the drug in a format that the attorney general 12
56	56	determines to be understandable and appropriate. The manufacturer shall submit to the office of 13
57	57	the attorney general all relevant information and supporting documentation necessary to justify the 14
58	58	manufacturer's wholesale acquisition cost increase, which may include: 15
59	59	(i) All factors that have contributed to the wholesale acquisition cost increase; 16
60	60	(ii) The percentage of the total wholesale acquisition cost increase attributable to each 17
61	61	factor; and 18
62	62	(iii) An explanation of the role of each factor in contributing to the wholesale acquisition 19
63	63	cost increase. 20
64	64	(2) Nothing in this section shall be construed to restrict the legal ability of a prescription 21
65	65	drug manufacturer to change prices to the extent permitted under federal law. 22
66	66	(c) The attorney general, in consultation with the department, shall provide a report to the 23
67	67	general assembly on or before December 1 of each year based on the information received from 24
68	68	manufacturers pursuant to this section. The attorney general shall also post the report on the office 25
69	69	of the attorney general's website. 26
70	70	(d) Information provided to the office of the attorney general pursuant to this section is 27
71	71	exempt from public inspection and copying and is not a public record pursuant to chapter 2 of title 28
72	72	38 ("access to public records"), and shall not be released in a manner that allows for the 29
73	73	identification of an individual drug or manufacturer or that is likely to compromise the financial, 30
74	74	competitive, or proprietary nature of the information. 31
75	75	5-19.3-4. Injunctive relief. 32
76	76	The attorney general may bring a civil action in the superior court for Providence county 33
77	77	for injunctive relief, costs, and attorneys' fees, and to impose on a manufacturer that fails to provide 34
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81	81	the information required by § 5-19.3-3(b) a civil penalty of no more than ten thousand dollars 1
82	82	($10,000) per violation. Each unlawful failure to provide information shall constitute a separate 2
83	83	violation. 3
84	84	5-19.3-5. Rulemaking. 4
85	85	(a) On or before January l, 2024, the insurance commissioner shall adopt rules and 5
86	86	regulations to require all health insurers that offer health benefit plans to Rhode Island residents 6
87	87	through HealthSource RI or any successor health benefit exchange to provide information to 7
88	88	enrollees, potential enrollees, and health care providers about the exchange plans' prescription drug 8
89	89	formularies. 9
90	90	(b) The rules shall ensure that: 10
91	91	(1) The formulary is posted online in a standard format established by the insurance 11
92	92	commissioner; 12
93	93	(2) The formulary is updated frequently and is searchable by enrollees, potential enrollees, 13
94	94	and health care providers; and 14
95	95	(3) The formulary includes information about the prescription drugs covered, applicable 15
96	96	cost-sharing amounts, drug tiers, prior authorization, step therapy, and utilization management 16
97	97	requirements. 17
98	98	5-19.3-6. Dispensing fees. 18
99	99	(a) The department shall use the same dispensing fee in its reimbursement formula for 19
100	100	340B prescription drugs as the department uses to pay for non-340B prescription drugs under the 20
101	101	Medicaid program. 21
102	102	(b) Notwithstanding the provisions of subsection (a) of this section, the department is 22
103	103	authorized to modify the dispensing fee or reimbursement formula provided to federally qualified 23
104	104	health centers and Title X family planning clinics for dispensing 340B prescription drugs to 24
105	105	Medicaid beneficiaries. 25
106	106	5-19.3-7. Drug reimbursement - Reporting. 26
107	107	(a) The department shall: 27
108	108	(1) Determine the formula used by other states' Medicaid programs to reimburse covered 28
109	109	entities that use 340B pricing for dispensing prescription drugs to Medicaid beneficiaries; 29
110	110	(2) Evaluate the advantages and disadvantages of using the same dispensing fee in its 30
111	111	reimbursement formula for 340B prescription drugs as the department uses to pay for non-340B 31
112	112	prescription drugs under the Medicaid program; and 32
113	113	(3) Identify the benefits, if any, of 340B drug pricing to consumers, other payers, and the 33
114	114	overall health care system. 34
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118	118	(b) On or before March 15, 2024, the department shall report to the house of 1
119	119	representatives, the senate, and the governor's office regarding its findings and recommendations, 2
120	120	including recommended modifications to Rhode Island's 340B reimbursement formula, if any, and 3
121	121	the financial implications of implementing any recommended modifications. 4
122	122	5-19.3-8. Out-of-pocket prescription drug limits – Advisory commission. 5
123	123	(a) The Rhode Island department of health shall convene an advisory commission to 6
124	124	develop options for all qualified health benefit plans to be offered on the Rhode Island health benefit 7
125	125	exchange for the 2025 plan year, including: 8
126	126	(1) One or more plans with a higher out-of-pocket limit on prescription drug coverage than 9
127	127	the limit established pursuant to current law and regulations; and 10
128	128	(2) Two (2) or more plans with an out-of-pocket limit at or below the limit established 11
129	129	pursuant to current law and regulations. 12
130	130	(b) The advisory commission shall include at least the following members: 13
131	131	(1) A representative of the Rhode Island health benefits exchange, appointed by the 14
132	132	governor; 15
133	133	(2) A representative of each of the commercial health insurers offering plans on the Rhode 16
134	134	Island health benefit exchange, appointed by each insurer; 17
135	135	(3) The insurance commissioner, or designee; 18
136	136	(4) A representative of the exchange advisory board established pursuant to § 42-157-7, 19
137	137	appointed by the governor; 20
138	138	(4) A representative of a Rhode Island AIDS services organization, appointed by the 21
139	139	governor; 22
140	140	(5) The director of the department of administration, or designee; 23
141	141	(6) The director of the department of health, or designee; 24
142	142	(7) A consumer nominated by a Rhode Island AIDS services organization and appointed 25
143	143	by the governor; 26
144	144	(8) A representative of the American Cancer Society appointed by the governor; and 27
145	145	(9) A consumer nominated by the American Cancer Society and appointed by the governor. 28
146	146	(c)(1) The advisory commission shall meet at least six (6) times prior to the department 29
147	147	submitting plan designs to the state board of pharmacy for approval. 30
148	148	(2) In developing the standard qualified health benefit plan designs for the 2025 plan year, 31
149	149	the department shall present the recommendations of the advisory commission established pursuant 32
150	150	to this section. 33
151	151	5-19.3-9. Reports. 34
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155	155	(a) On or before February 15, 2024, the department shall provide to the governor, the house 1
156	156	of representatives, and the senate: 2
157	157	(1) An overview of the cost-share increase trend for all qualified health benefit plans 3
158	158	offered on the Rhode Island health benefit exchange for the 2018 through 2023 plan years that were 4
159	159	subject to the out-of-pocket prescription drug limit established in state law or regulation; 5
160	160	(2) Detailed information regarding lower cost-sharing amounts for selected services that 6
161	161	will be available in all qualified health benefit plans in the 2024 plan year due to the flexibility to 7
162	162	increase the out-of-pocket prescription drug limits established pursuant to this chapter; 8
163	163	(3) A comparison of the bronze-level qualified health benefit plans offered in the 2024 plan 9
164	164	year in which there will be flexibility in the out-of-pocket prescription drug limit established under 10
165	165	state law and regulation; 11
166	166	(4) Information about the process engaged in by the advisory commission established in 12
167	167	this chapter and the information considered to determine modifications to the cost-sharing amounts 13
168	168	in all qualified health benefit plans for the 2024 plan year, including prior year utilization trends, 14
169	169	feedback from consumers and health insurers, health benefit exchange outreach and education 15
170	170	efforts, and relevant national studies; 16
171	171	(5) Cost-sharing information for standard qualified health benefit plans from states with 17
172	172	federally-facilitated exchanges compared to those on the Rhode Island health benefit exchange; 18
173	173	and 19
174	174	(6) An overview of the outreach and education plan for enrollees in all qualified health 20
175	175	benefit plans offered on the Rhode Island health benefit exchange. 21
176	176	(b) On or before February l, 2025, the department shall report to the governor, the house 22
177	177	of representatives, and the senate: 23
178	178	(1) Enrollment trends in all qualified health benefit plans offered on the Rhode Island 24
179	179	health benefit exchange; and 25
180	180	(2) Recommendations from the advisory commission established pursuant to § 5-19.3-8 26
181	181	regarding modification of out-of-pocket prescription drug cost limits. 27
182	182	SECTION 2. This act shall take effect upon passage. 28
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184	184	LC000173
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188	188	LC000173 - Page 6 of 6
189	189	EXPLANATION
190	190	BY THE LEGISLATIVE COUNCIL
191	191	OF
192	192	A N A C T
193	193	RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACEUTICAL COST
194	194	TRANSPARENCY
195	195	***
196	196	This act would direct the state board of pharmacy, in collaboration with the department of 1
197	197	health, to annually identify up to fifteen (15) prescription drugs on which the state spends 2
198	198	significant health care dollars due to increases in costs. This list would be provided to the attorney 3
199	199	general's office, and the attorney general's office would require the drug's manufacturers to submit 4
200	200	relevant information and documentation to justify these cost increases. The act would also direct 5
201	201	the department of health to use the same dispensing fee in its reimbursement formula for 340B 6
202	202	prescription drugs as it uses to pay for non-340B prescription drugs under the Medicaid program, 7
203	203	and to provide information to the general assembly and the governor about these programs. The act 8
204	204	would also establish an advisory commission on out-of-pocket prescription drug costs who would 9
205	205	study these costs and make reports and recommendations to the governor and the general assembly. 10
206	206	This act would take effect upon passage. 11
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