AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

HB 7816 requires pharmacy benefit managers (PBMs) in Rhode Island to provide written medical justification when denying coverage for prescription drugs. The bill mandates that denials include a detailed, clinically supported reason based on recognized medical standards, reviewed by a licensed healthcare professional, and delivered simultaneously to both the prescribing provider and the patient. It applies to all prescription drug benefit denials under insurance plans governed by Rhode Island law, without changing the terms of the insurance contracts themselves. The law takes effect on January 1, 2027.