summary
Introduced
02/07/2025
02/07/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Pharmacy Benefit Manager Article of the Illinois Insurance Code. Provides that a covered individual's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80% of all rebates received, or to be received, or to be received, in connection with the dispensing or administration of the prescription drug. Provides that a health insurer or its agents shall not publish or otherwise reveal information regarding the actual amount of rebates a health insurer receives on a product or therapeutic class of products, manufacturer-specific basis, or pharmacy-specific basis and that the information is confidential. Defines terms. Amends the Freedom of Information Act to make a conforming change. Amends the Pharmacy Practice Act. Provides that a pharmacist may substitute a biological product (instead of an interchangeable biological product) if, among other requirements, the product being considered for substitution is either the reference product or a product approved by the United States Food and Drug Administration as a biosimilar of the prescribed biological product (instead of if the substituted product has been determined by the United States Food and Drug Administration to be interchangeable with the prescribed biological product). Makes conforming changes.
AI Summary
This bill introduces several key changes to pharmacy and insurance regulations in Illinois. It amends the Illinois Insurance Code to require that a patient's out-of-pocket costs for prescription drugs be calculated at the point of sale using a price reduced by at least 80% of all rebates received by health insurers. The bill also mandates that information about these rebates remain confidential and prohibits health insurers from publicly disclosing specific details about rebate amounts. Additionally, the bill modifies the Pharmacy Practice Act to expand pharmacists' ability to substitute biological products, allowing substitution for any FDA-approved reference or biosimilar product, rather than only interchangeable products. The Freedom of Information Act is also updated to accommodate these changes, ensuring that rebate-related information is considered protected and confidential. The provisions will apply to insurance contracts entered into or renewed on or after January 1, 2026, giving insurers and pharmacies time to adapt to the new requirements. These changes aim to potentially reduce prescription drug costs for consumers and protect sensitive financial information in the healthcare industry.
Committee Categories
Health and Social Services
Sponsors (1)
Last Action
Rule 19(a) / Re-referred to Rules Committee (on 03/21/2025)
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=3794&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB3794.htm |
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