Home Economy R.I. Senate approves bills restricting ‘spread pricing’ on prescription meds

R.I. Senate approves bills restricting ‘spread pricing’ on prescription meds

By

Christopher Allen

-

05/07/2025

Drugstore Challenges — THE R.I. SENATE has approved two bills aimed at ending the use of “spread pricing” by pharmacy benefit managers, a practice often charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy./ ASSOCIATED PRESS FILE PHOTO/CHRIS CARLSON

PROVIDENCE – The R.I. Senate has approved a pair of bills targeting the use of “spread pricing” by pharmacy benefit managers, which often charge health plans and payers a higher price for a prescription drug than what they reimburse to the pharmacy and keep the difference. Legislation sponsored by Sen. Lori Urso, D-Pawtucket, would prohibit

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PROVIDENCE – The R.I. Senate has approved a pair of bills targeting the use of “spread pricing” by pharmacy benefit managers, which often charge health plans and payers a higher price for a prescription drug than what they reimburse to the pharmacy and keep the difference. Legislation sponsored by Sen. Lori Urso, D-Pawtucket, would prohibit PBMs from using spread pricing in their cost structures related to commercial health care plans, while another bill filed by Sen. Linda L. Ujifusa, D-Portsmouth, would prohibit spread pricing by PBMs working for the managed care organizations that manage Medicaid plans for approximately 90% of enrollees, according to a legislative press release. Both bills are part of a nine-piece healthcare package and now head to the R.I. House, where no votes have been scheduled as of Wednesday. The National Community Pharmacists Association estimates that PBMs add about 30 cents per dollar to the price consumers pay for prescriptions. The practice can also lead to lower reimbursements for independent pharmacies not partnered with a PBM. There are about 60 PBMs in the country, but the industry is dominated by Express Scripts Holding Co., OptumRx, and CVS Caremark, which is owned by Woonsocket-based pharmacy chain CVS Health Corp. Seeking to lower the cost medical systems pay for prescription drugs, in a statement Urso said the law would also save Rhode Island taxpayers “even if they don’t regularly use prescription drugs," and called independent pharmacies “often the hardest hit" by a practice that has become “a common and unnecessary burden on payers and pharmacies.” “We must pursue PBM middlemen who take too many dollars away from actual health care providers, patients and taxpayers,” added Ujifusa. Spread pricing has increasingly become the subject of legal challenges. The Trump administration in April temporarily halted a Federal Trade Commission lawsuit brought last year against the three largest PBMs for alleged anticompetitive rebating practices that artificially inflated the price of insulin drugs. Last month a federal judicial panel ordered a multidistrict lawsuit from several independent pharmacies alleging that GoodRx and PBMs, including CVS Caremark, conspired to steer patients toward PBM-affiliated pharmacies be sent to Rhode Island U.S. District Court for pre-trial. Calling the venue an “appropriate” and “relatively underutilized" district, the order cited CVS Caremark being headquartered in Rhode Island, a state where “relevant witnesses and documents may be located.” Christopher Allen is a PBN staff writer. You may contact him at Allen@PBN.com