2025 -- S 0897
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LC002198
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
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A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senator Louis P. DiPalma
Date Introduced: March 27, 2025
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
Policies" is hereby amended by adding thereto the following section: 2
27-18-95. Coverage for pharmacists' services. 3
(a) Every group health insurance contract, or every group hospital or medical expense 4
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 5
any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 6
within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 7
services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 8
would have provided coverage if the service had been performed by a physician, advanced practice 9
nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 10
signature, or referral by any other healthcare provider as a condition of reimbursement to a 11
pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 12
duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 13
following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 14
unless paid by another mechanism, include: 15
(1) Evaluation and management of a patient, which requires a medically appropriate history 16
and/or examination and medical decision making; 17
(2) Medication therapy management review; 18
(3) Immunization education and administration; 19
LC002198 - Page 2 of 7
(4) Administration of medications; and 1
(5) Ordering and evaluation of clinical laboratory tests. 2
(b) The health plan shall include an adequate number of pharmacists in its network of 3
participating medical providers. The participation of pharmacies in the plan network's drug benefit 4
shall not satisfy the requirement that plans include pharmacists in their networks of participating 5
medical providers. 6
(c) The healthcare benefits outlined in this section apply only to services delivered within 7
the health insurer's provider network; provided that, all health insurers shall be required to provide 8
coverage for those benefits required by the provisions of this section outside of the health insurer's 9
provider network where it can be established that the required services are not available from a 10
provider in the health insurer's network. 11
(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 12
extended by the general assembly. 13
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 14
Corporations" is hereby amended by adding thereto the following section: 15
27-19-87. Coverage for pharmacists' services. 16
(a) Every group health insurance contract, or every group hospital or medical expense 17
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 18
any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 19
within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 20
services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 21
would have provided coverage if the service had been performed by a physician, advanced practice 22
nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 23
signature, or referral by any other healthcare provider as a condition of reimbursement to a 24
pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 25
duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 26
following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 27
unless paid by another mechanism, include: 28
(1) Evaluation and management of a patient, which requires a medically appropriate history 29
and/or examination and medical decision making; 30
(2) Medication therapy management review; 31
(3) Immunization education and administration; 32
(4) Administration of medications; and 33
(5) Ordering and evaluation of clinical laboratory tests. 34
LC002198 - Page 3 of 7
(b) The health plan shall include an adequate number of pharmacists in its network of 1
participating medical providers. The participation of pharmacies in the plan network's drug benefit 2
shall not satisfy the requirement that plans include pharmacists in their networks of participating 3
medical providers. 4
(c) The healthcare benefits outlined in this section apply only to services delivered within 5
the health insurer's provider network; provided that, all health insurers shall be required to provide 6
coverage for those benefits required by the provisions of this section outside of the health insurer's 7
provider network where it can be established that the required services are not available from a 8
provider in the health insurer's network. 9
(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 10
extended by the general assembly. 11
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 12
Corporations" is hereby amended by adding thereto the following section: 13
27-20-83. Coverage for pharmacists' services. 14
(a) Every group health insurance contract, or every group hospital or medical expense 15
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 16
any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 17
within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 18
services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 19
would have provided coverage if the service had been performed by a physician, advanced practice 20
nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 21
signature, or referral by any other healthcare provider as a condition of reimbursement to a 22
pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 23
duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 24
following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 25
unless paid by another mechanism, include: 26
(1) Evaluation and management of a patient, which requires a medically appropriate history 27
and/or examination and medical decision making; 28
(2) Medication therapy management review; 29
(3) Immunization education and administration; 30
(4) Administration of medications; and 31
(5) Ordering and evaluation of clinical laboratory tests. 32
(b) The health plan shall include an adequate number of pharmacists in its network of 33
participating medical providers. The participation of pharmacies in the plan network's drug benefit 34
LC002198 - Page 4 of 7
shall not satisfy the requirement that plans include pharmacists in their networks of participating 1
medical providers. 2
(c) The healthcare benefits outlined in this section apply only to services delivered within 3
the health insurer's provider network; provided that, all health insurers shall be required to provide 4
coverage for those benefits required by the provisions of this section outside of the health insurer's 5
provider network where it can be established that the required services are not available from a 6
provider in the health insurer's network. 7
(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 8
extended by the general assembly. 9
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 10
Organizations" is hereby amended by adding thereto the following section: 11
27-41-100. Coverage for pharmacists' services. 12
(a) Every group health insurance contract, or every group hospital or medical expense 13
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 14
any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 15
within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 16
services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 17
would have provided coverage if the service had been performed by a physician, advanced practice 18
nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 19
signature, or referral by any other healthcare provider as a condition of reimbursement to a 20
pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 21
duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 22
following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 23
unless paid by another mechanism, include: 24
(1) Evaluation and management of a patient, which requires a medically appropriate history 25
and/or examination and medical decision making; 26
(2) Medication therapy management review; 27
(3) Immunization education and administration; 28
(4) Administration of medications; and 29
(5) Ordering and evaluation of clinical laboratory tests. 30
(b) The health plan shall include an adequate number of pharmacists in its network of 31
participating medical providers. The participation of pharmacies in the plan network's drug benefit 32
shall not satisfy the requirement that plans include pharmacists in their networks of participating 33
medical providers. 34
LC002198 - Page 5 of 7
(c) The healthcare benefits outlined in this section apply only to services delivered within 1
the health insurer's provider network; provided that, all health insurers shall be required to provide 2
coverage for those benefits required by the provisions of this section outside of the health insurer's 3
provider network where it can be established that the required services are not available from a 4
provider in the health insurer's network. 5
(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 6
extended by the general assembly. 7
SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby 8
amended by adding thereto the following section: 9
40-8-33. Coverage for pharmacists' services. 10
(a) The executive office of health and human services is directed and authorized to establish 11
coverage for the services within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-12
2, and pharmacists' services provided under a "collaborative practice agreement" defined in § 5-13
19.2-2, if the plan would have provided coverage if the service had been performed by a physician, 14
advanced practice nurse, or physician assistant. The following services would qualify as being 15
eligible for payment and reimbursement to a pharmacist, unless paid by another mechanism, 16
include: 17
(1) Evaluation and management of a patient, which requires a medically appropriate history 18
and/or examination and medical decision making; 19
(2) Medication therapy management review; 20
(3) Immunization education and administration; 21
(4) Administration of medications; and 22
(5) Ordering and evaluation of clinical laboratory tests. 23
(b) The health plan shall include pharmacists in its network of participating medical 24
providers. The participation of pharmacies in the plan network's drug benefit shall not satisfy the 25
requirement that plans include pharmacists in their networks of participating medical providers. 26
(c) The healthcare benefits outlined in this section apply only to services delivered within 27
the health insurer's provider network; provided that, all health insurers shall be required to provide 28
coverage for those benefits required by the provisions of this section outside of the health insurer's 29
provider network where it can be established that the required services are not available from a 30
provider in the health insurer's network. 31
(d) The executive office of health and department of human services shall apply to the 32
United States department of health and human services for any amendment to the state Medicaid 33
plan or for any Medicaid waiver as necessary to implement this section. The executive office of 34
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health and human services shall submit the Medicaid state plan amendment not later than 1
September 1, 2025. 2
(e) The provisions of this section shall sunset and expire on January 1, 2030, unless 3
extended by the general assembly. 4
SECTION 6. This act shall take effect on January 1, 2026, and unless extended by the 5
general assembly, shall expire on January 1, 2030. 6
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would require health insurance providers to provide insurance coverage for 1
pharmacists’ services including evaluation and management of a patient, which requires a 2
medically appropriate history and/or examination and medical decision making; medication 3
therapy management review; immunization education and administration; administration of 4
medications; ordering and evaluation of clinical laboratory tests. 5
This act would take effect on January 1, 2026, and unless extended by the general assembly, 6
would expire on January 1, 2030. 7
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LC002198
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