summary
Introduced
02/02/2026
02/02/2026
In Committee
02/06/2026
02/06/2026
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Illinois Insurance Code. In provisions concerning pharmacy benefit manager contracts, provides that a pharmacy benefit manager must 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 of $10.49. Provides that, if the national average drug acquisition cost is not available at the time a drug is administered or dispensed, a pharmacy benefit manager may not reimburse in an amount that is less than the wholesale acquisition cost of the drug, plus a professional dispensing fee of $10.49.
AI Summary
This bill amends the Illinois Insurance Code to establish new minimum reimbursement requirements for pharmacy benefit managers (PBMs), which are entities that manage prescription drug benefits for health plans. Specifically, PBMs must reimburse pharmacies or pharmacists at least the national average drug acquisition cost (NADAC) for a prescription drug or pharmacy service, plus a professional dispensing fee of $10.49. If the NADAC is unavailable, the PBM must reimburse at least the wholesale acquisition cost (WAC) of the drug, also plus the $10.49 dispensing fee. The NADAC is a federal program that reports average acquisition costs for drugs, while WAC is the manufacturer's suggested list price for a drug. These provisions aim to ensure fair compensation for pharmacies when dispensing medications.
Sponsors (1)
Last Action
Referred to Rules Committee (on 02/06/2026)
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