summary
Introduced
01/09/2025
01/09/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Illinois Insurance Code. Defines "health benefit plan" and other terms. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf is prohibited from conducting spread pricing, from steering a covered individual, and from limiting a covered individual's access to prescription drugs from a pharmacy or pharmacist enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area by unreasonably designating the covered prescription drugs as a specialty drug. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf must remit 100% of rebates and fees to the health benefit plan sponsor, consumer, or employer. Provides that a pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee. Provides that a contract between a pharmacy benefit manager and an insurer or health benefit plan sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at least once per calendar year of the rebate and fee records remitted from a pharmacy benefit manager or its contracted party to a health benefit plan. Provides that provisions concerning pharmacy benefit manager contracts apply to any health benefit plan (instead of any group or individual policy of accident and health insurance or managed care plan) that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020. Requires a pharmacy benefit manager to submit an annual report that includes specified information concerning prescription drugs. Makes other changes. Amends the Freedom of Information Act to make a conforming change. Effective July 1, 2025.
AI Summary
This bill aims to regulate pharmacy benefit managers (PBMs) in Illinois by introducing several key provisions to increase transparency, protect consumers, and ensure fair practices in prescription drug pricing and distribution. The bill defines terms like "health benefit plan" and "covered individual" and prohibits PBMs from engaging in spread pricing, which is a pricing model where the PBM charges a health plan more for prescription drugs than it pays pharmacies. PBMs are also banned from steering patients to specific pharmacies and must remit 100% of rebates and fees to health benefit plan sponsors, consumers, or employers. The bill requires PBMs to reimburse pharmacies at least the national average drug acquisition cost plus a $10.49 professional dispensing fee and prevents them from unreasonably designating prescription drugs as specialty drugs to limit patient access. Additionally, the bill mandates that PBMs submit an annual report to the health benefit plan sponsor and the state, detailing various aspects of prescription drug coverage, such as drug lists, rebates, spending, and pharmacy compensation. Failure to submit these reports can result in daily fines up to $1,000. The bill is designed to increase transparency, reduce hidden costs, and protect consumers' access to affordable prescription medications.
Committee Categories
Health and Social Services
Sponsors (2)
Last Action
Added Co-Sponsor Rep. Janet Yang Rohr (on 04/10/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ilga.gov/legislation/BillStatus.asp?DocNum=1159&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB1159.htm |
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