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IL HB1443

IL HB1443
HEALTH CARE AVAILABILITY


summary

Introduced
01/17/2025
In Committee
04/17/2026
Crossed Over
Passed
Dead

Introduced Session

104th General Assembly

Bill Summary

Reinserts the provisions of the introduced bill with the following changes. Makes changes to defined terms. Replaces references to the Health Care Availability and Access Board, the Health Care Availability and Access Stakeholder Council, and the Health Care Availability and Access Board Fund to the Prescription Drug Affordability Board, the Prescription Drug Affordability Stakeholder Council, and the Prescription Drug Affordability Board Fund. Requires Prescription Drug Affordability Board membership to also include individuals with expertise in the practice of pharmacy. Includes reimbursements from health benefit plans in provisions concerning upper payment limits for payor reimbursements. Requires the Board to maintain financial records and accounts in accordance with generally accepted governmental accounting principles. Provides that the Board shall be deemed a public body for purposes of the Freedom of Information Act and the Open Meetings Act; all records of the Board, including meeting minutes, cost review records, and correspondence, shall be public records subject to disclosure in accordance with the Freedom of Information Act, except as otherwise provided by law; and meetings of the Board shall be open to the public in accordance with the Open Meetings Act. Requires the Board to establish an operational plan for distribution and access to a drug with an upper payment limit before the Board reviews specific drugs for affordability and establishes any upper payment limits. Provides that the Board shall prioritize establishing and implementing upper payment limits for the 10 prescription drug products with a Medicare Maximum Fair Price that went into effect in 2026 before proceeding with upper payment limits on other prescription drug products with a Medicare Maximum Fair Price or affordability reviews for any other prescription drug products. Adds more items to the list of information that may be included to conduct an affordability review. Provides that the Board may suspend an upper payment limit if it determines that there is a shortage of the drug in the State unless the Board determines that the shortage was caused by a manufacturer or its agent. Changes expertise requirements for membership of the Prescription Drug Affordability Stakeholder Council. Establishes specified exemptions for the Department of Healthcare and Family Services and other State departments in provisions concerning protections and other Board considerations. Provides that any upper payment limit established by the Board shall not apply to prescription drug products purchased by the Department of Healthcare and Family Services for the medical assistance program under Article V of the Illinois Public Aid Code or to a health care plan serving Medicaid populations that provides, arranges for, pays for, or reimburses the cost of any health care service for persons who are enrolled under the medical assistance program under Article V of the Illinois Public Aid Code unless, after consultation with and approval of the Director of Healthcare and Family Services, it is determined that the upper payment limit would reduce costs to the State. Provides that, if a prescription drug product subject to an upper payment limit established under the Act is intended to be made available for purchase by pharmacies, distributors, or wholesalers licensed in the State, it shall be available at a price that does not exceed the upper payment limit (rather than a wholesaler or distributor shall make any prescription drug product that is subject to an upper payment limit established under the Act available for purchase by pharmacies licensed in this State at a price that does not exceed the established upper payment limit), and, if a wholesaler or distributor acquires a prescription drug product subject to an upper payment limit at a price that exceeds the upper payment limit, the wholesaler or distributor is entitled to a chargeback or rebate equal to the difference between the price and the upper payment limit from the entity that sold the product to the wholesaler or distributor. Changes the required reporting date for the Board concerning the operation of the generic drug market in the United States to June 1, 2027 (rather than June 1, 2025). Requires the Board to notify the General Assembly if 5 years have passed without any litigation hindering Board operations. Provides that the Act is repealed 5 years after the effective date of the Act. Makes other changes. Effective 180 days after becoming law.

AI Summary

This bill establishes the Prescription Drug Affordability Board (Board) and the Prescription Drug Affordability Stakeholder Council (Council) to protect residents from high prescription drug costs, replacing previous references to the Health Care Availability and Access Board and related entities. The Board, composed of five members with expertise in health care economics, pharmaceutical markets, pharmacy practice, and clinical medicine, will review prescription drug products to determine if they create affordability challenges. The Council will provide stakeholder input to the Board. The Board is required to develop an operational plan for drug distribution and access before setting upper payment limits, and will prioritize setting these limits for the top 10 prescription drugs with a Medicare Maximum Fair Price that went into effect in 2026. The bill outlines specific criteria for drug cost reviews, including wholesale acquisition costs and price increases, and details the types of information the Board can consider, such as manufacturer pricing strategies, patient assistance programs, and net costs to state payers. The Board can suspend an upper payment limit if a drug shortage occurs, unless the shortage was caused by the manufacturer. The bill also includes exemptions for certain state departments, like the Department of Healthcare and Family Services, from upper payment limits under specific conditions, and clarifies that upper payment limits apply to the ingredient cost of drugs, not dispensing fees. The Board will be funded by an annual assessment on manufacturers, with a cap of $750,000 per year, and its operations will be subject to the Freedom of Information Act and the Open Meetings Act, meaning its records and meetings will be public. The Act is set to be repealed five years after its effective date.

Committee Categories

Health and Social Services

Sponsors (30)

Last Action

House Floor Amendment No. 3 Rule 19(c) / Re-referred to Rules Committee (on 04/17/2026)

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