The enactment of H5620 will significantly alter the landscape of pharmaceutical pricing within the state. Specifically, manufacturers will be subjected to a penalty equal to 80% of the revenue difference caused by unsupported price increases. Such measures are designed to deter arbitrary price hikes and require manufacturers to maintain their pricing in accordance with the wholesale acquisition costs from the previous year, adjusted for inflation. This is expected to provide financial relief to consumers and improve access to necessary medications.
Summary
House Bill H5620, also referred to as 'The Rhode Island Health Care Reform Act of 2024', addresses the management of health insurance oversight specifically concerning the regulation of prescription drug pricing. The bill introduces measures aimed at controlling unsupported price increases for prescription drugs and imposes stringent penalties on manufacturers who do not comply. The primary objective of this legislation is to enhance the accountability of drug manufacturers in their pricing strategies and ensure that drug prices reflect reasonable increases based on evidence of clinical efficacy.
Contention
The bill faces contention primarily from pharmaceutical companies that may see these regulations as burdensome and restrictive on their operational flexibility. Critics argue that the penalties for withdrawing drugs from the market could reduce the overall availability of necessary medications, particularly if manufacturers feel pressured by potential fines. Additionally, discussions surrounding what constitutes an 'unsupported price increase' may lead to further debates about pharmaceutical pricing transparency and the role of clinical evidence in determining appropriate drug costs.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Protects the solvency of health systems, physicians, and advance practice providers and insurers, encourage fair treatment of hospitals and ensure adequate clinical workforce while advancing health equity.
Protects the solvency of health systems, physicians, and advance practice providers and insurers, encourage fair treatment of hospitals and ensure adequate clinical workforce while advancing health equity.
Requires that the department of human services and the department of behavioral healthcare, developmental disabilities and hospitals provide forecasted costs reflecting the recommended rate review on a monthly basis.
Establishes a process whereby large drug manufacturers, may be penalized for prescription drug price increases where there is no, or inadequate, new evidence to support the price increase.