Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall not enter into a contract with a managed care organization that relies on a pharmacy benefit manager that does not do the following: (i) utilize a pharmacy reimbursement methodology of the lesser of national average drug acquisition cost plus a professional dispensing fee as determined by the Department, the wholesale acquisition cost plus a professional dispensing fee as determined by the Department, or the usual and customary charge by the pharmacy; (ii) reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; (iii) agree to move to a transparent pass-through pricing model, in which the pharmacy benefit manager discloses the administrative fee as a percentage of the professional dispensing costs to the Department; (iv) agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and (v) agree to not terminate an existing contract with a pharmacy licensed under the Pharmacy Practice Act for the sole reason of the additional professional dispensing fee authorized under item (i). Requires each pharmacy benefit manager that receives reimbursement for medical services, either directly or through a Medicaid managed care health plan, to submit by January 15, 2026, and each January 15 thereafter, certain data and information to the Department for the previous fiscal year, including: (1) the total number of prescriptions that were dispensed; (2) the aggregate wholesale acquisition cost for each drug on its formulary; (3) the aggregate amount of rebates, discounts, and price concessions that the pharmacy benefit manager received for each drug on its formulary; (4) the aggregate amount of administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers; and (5) any other information considered necessary by the Department. Requires the Department to submit such data and information to the General Assembly and to the Governor's Office of Management and Budget. Provides that such information is confidential and not subject to disclosure under the Freedom of Information Act.

Spectrum: Slight Partisan Bill (Democrat 5-3)

Status: (Introduced) 2024-05-02 - Added as Co-Sponsor Sen. Dale Fowler [SB2790 Detail]

Text: Latest bill text (Introduced) [HTML]

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Sponsors

Name	Type	Sponsorship	District	Financial	Encyclopedia	Biography
Senator David Koehler [D]	Primary	Sponsored Bills	SD-046	FollowTheMoney	Ballotpedia	VoteSmart
Senator Laura Murphy [D]	Cosponsor	Sponsored Bills	SD-028	FollowTheMoney	Ballotpedia	VoteSmart
Senator Patrick Joyce [D]	Cosponsor	Sponsored Bills	SD-040	FollowTheMoney	Ballotpedia	VoteSmart
Senator Cristina Castro [D]	Cosponsor	Sponsored Bills	SD-022	FollowTheMoney	Ballotpedia	VoteSmart
Senator Steve McClure [R]	Cosponsor	Sponsored Bills	SD-054	FollowTheMoney	Ballotpedia	VoteSmart
Senator Sally Turner [R]	Cosponsor	Sponsored Bills	SD-044	FollowTheMoney	Ballotpedia	VoteSmart
Senator Doris Turner [D]	Cosponsor	Sponsored Bills	SD-048	FollowTheMoney	Ballotpedia	VoteSmart
Senator Dale Fowler [R]	Cosponsor	Sponsored Bills	SD-059	FollowTheMoney	Ballotpedia	VoteSmart

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