Bill Text: IL HB3787 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Pharmacy Benefit Managers Article of the Illinois Insurance Code. Provides that a pharmacy benefit manager shall not: steer a beneficiary; order a covered individual to fill a prescription or receive pharmacy care services from an affiliated pharmacy; reimburse a pharmacy or pharmacist for a pharmaceutical product or pharmacist service in an amount less than the amount that the pharmacy benefit manager reimburses itself or an affiliate for providing the same product or services; offer or implement plan designs that require patients to use an affiliated pharmacy; or advertise, market, or promote a pharmacy by an affiliate to patients or prospective patients. Defines terms.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2023-03-10 - Rule 19(a) / Re-referred to Rules Committee [HB3787 Detail]

Download: Illinois-2023-HB3787-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3787 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED:
215 ILCS 5/513b1.5 new
Amends the Pharmacy Benefit Managers Article of the Illinois Insurance Code. Provides that a pharmacy benefit manager shall not: steer a beneficiary; order a covered individual to fill a prescription or receive pharmacy care services from an affiliated pharmacy; reimburse a pharmacy or pharmacist for a pharmaceutical product or pharmacist service in an amount less than the amount that the pharmacy benefit manager reimburses itself or an affiliate for providing the same product or services; offer or implement plan designs that require patients to use an affiliated pharmacy; or advertise, market, or promote a pharmacy by an affiliate to patients or prospective patients. Defines terms.
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
adding Section 513b1.5 as follows:
(215 ILCS 5/513b1.5 new)
Sec. 513b1.5. Steering prohibition.
(a) As used in this Section:
"Covered individual" means a member, participant,
enrollee, contract holder, policyholder, or beneficiary of a
carrier, insurer, or issuer who is provided a prescription
drug benefit by the carrier, insurer, or issuer. "Covered
individual" includes a dependent or other person provided a
prescription drug benefit through a policy, contract, or plan
for a covered individual.
"Pharmacy benefit management" means a service provided to
covered entities to facilitate the provision of prescription
drug benefits to covered individuals for dispensation within
this State, including negotiating pricing and other terms with
drug manufacturers and retail pharmacies. "Pharmacy benefit
management" includes the following:
(1) claims processing, retail network management, and
payment of claims to pharmacies for prescription drugs

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dispensed to covered individuals for dispensation within
this State;
(2) clinical formulary development and management
services;
(3) rebate contracting and administration;
(4) certain covered individual compliance, therapeutic
intervention, and generic substitution programs; and
(5) disease management programs.
"Pharmacy benefit manager" means any person that designs
or administers the prescription drug or device benefit of one
or more health plans on behalf of a third party irrespective of
whether such entity identifies itself as a pharmacy benefit
manager. "Pharmacy benefit manager" includes any agent,
affiliate, or representative of a health plan or pharmacy
benefit manager hired or contracted by a health plan or
pharmacy benefit manager to assist in designing or
administering the drug benefit and any wholly owned or
partially owned or controlled subsidiary of a pharmacy benefit
manager.
"Steer" includes, but is not limited to:
(1) requiring a beneficiary to use only a pharmacy,
including a mail-order pharmacy, in which the pharmacy
benefit manager maintains an ownership interest or
control;
(2) offering or implementing a plan design that
encourages a beneficiary to use a pharmacy in which the

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pharmacy benefit manager maintains an ownership interest
or control, if such plan design increases costs for the
beneficiary, including requiring a beneficiary to pay full
costs for a prescription if the beneficiary chooses not to
use a pharmacy owned or controlled by the pharmacy benefit
manager;
(3) reimbursing a pharmacy or pharmacist for a
pharmaceutical product or pharmacist service in an amount
less than the amount that the pharmacy benefit manager
reimburses itself or an affiliate for providing the same
product or services; or
(4) any other actions determined by the Department by
rule.
(b) A pharmacy benefit manager shall not:
(1) steer a beneficiary;
(2) order a covered individual to fill a prescription
or receive pharmacy care services from an affiliated
pharmacy;
(3) reimburse a pharmacy or pharmacist for a
pharmaceutical product or pharmacist service in an amount
less than the amount that the pharmacy benefit manager
reimburses itself or an affiliate for providing the same
product or services;
(4) offer or implement plan designs that require
patients to use an affiliated pharmacy; or
(5) advertise, market, or promote a pharmacy by an

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affiliate to patients or prospective patients.