Rhode Island H7816 mandates pharmacy benefit managers to provide medical justification for denying prescription drug claims.

Rhode Island H7816 requires pharmacy benefit managers to provide a medically sound justification for denying any claim for prescription drug benefits. This justification must be delivered in writing to both the prescribing provider and the patient. The notice must include sufficient detail to allow the provider and patient to understand the basis for denial and, if appropriate, submit an appeal or request for prior authorization.

Rhode Island H7816 mandates pharmacy benefit managers to provide medical justification for denying prescription drug claims.

Rhode Island H7816 requires pharmacy benefit managers to provide a medically sound justification for denying any claim for prescription drug benefits. This justification must be delivered in writing to both the prescribing provider and the patient. The notice must include sufficient detail to allow the provider and patient to understand the basis for denial and, if appropriate, submit an appeal or request for prior authorization.