All Roll Calls
Yes: 153 • No: 65
IllinoisHB0767104th General Assembly (2025–2026)HouseWALLET
REGULATION-TECH
Sponsored By: Sponsor information unavailable
Signed by Governor
Summary
Amends the Health Maintenance Organization Act. Makes a technical change in a Section concerning the short title.
executiveassignments
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Bill Overview
Analyzed Economic Effects
14 provisions identified: 11 benefits, 1 costs, 2 mixed.
Lower drug payments at the pharmacy
For a covered drug, your payment cannot exceed the lowest applicable plan cost sharing, uninsured retail price, or qualifying discount. A manufacturer voucher, no-cost drug program, or discounted health care services plan price counts when presented at sale. The rule covers affected insurer plans and qualifying state and local government plans. Insurers and pharmacy benefit managers cannot stop pharmacists from explaining when retail prices or alternative drugs cost less.
More protection for your pharmacy choice
Insurers, pharmacy benefit managers, and their affiliates cannot use prohibited steering practices to direct patients toward affiliated pharmacies. These practices include cost-increasing plan designs and paying another pharmacy less than their own affiliate. They also cannot misuse a specialty-drug label to block access to a participating pharmacy accepting terms offered throughout the coverage area. Agreements signed before the law's effective date remain controlling until their current term ends.
More no-cost preventive care coverage
Covered group and individual policies must cover state-recommended vaccines and medical countermeasures without copays, coinsurance, or deductibles. Coverage generally continues through the plan year when the recommendation applies at its start. Coverage can end sooner for a D-rated recommendation, a serious federal safety finding, or a safety recall. When state guidelines restore a federal vaccine recommendation that was reduced or withdrawn, coverage must begin within 15 business days. This deadline also applies to policies already in force; health savings account eligibility exceptions still apply.
More pharmacy staff can give vaccines
Pharmacists can vaccinate patients age 3 and older under a prescription or standing order. They cannot give children under 7 vaccines required by Illinois school immunization rules. Pharmacists can also give COVID-19 and flu vaccines without an order when federal authorization and state or federal guidance permit. Trained, supervised technicians and student pharmacists can give FDA-authorized, approved, or licensed COVID-19, flu, and respiratory syncytial virus vaccines by injection or nasal spray. Staff must meet training, CPR, registry, and reporting requirements, including 2 hours of immunization education per licensing period where required. Applicable payers, including Medicaid, must cover vaccines given under the specified order authority and pay at least physician rates.
No-cost coverage for three respiratory vaccines
Policies amended, delivered, issued, or renewed beginning January 1, 2026 must cover COVID-19, flu, and respiratory syncytial virus vaccines. Coverage includes administration fees without copays, coinsurance, or deductibles. Vaccines must have FDA authorization or licensing and follow Illinois guidelines or the federal vaccine advisory committee's standard schedule. If no contracted provider offers the vaccination, the plan must cover it elsewhere without cost sharing. Exceptions protect health savings account eligibility and exclude grandfathered plans, excepted benefits, and short-term limited-duration plans.
New grants for eligible Illinois pharmacies
Subject to appropriation, Illinois funds pharmacy-access grants through a statewide retail association representing pharmacies. Eligible applicants include critical access care pharmacies, qualifying independent pharmacies, and pharmacies in specified lower-population or underserved areas. Another category requires at least 65% Medicaid claims and at least 80% of total claims for pharmacy services administered in Illinois. Pharmacies can also qualify through the law's census-tract poverty or income standards combined with pharmacy-distance standards. Funds are split equally among eligible applicants without counting any pharmacy twice, with one award per pharmacy each fiscal year.
Pharmacy protections expand, with plan exclusions
Beginning July 1, 2025, Illinois pharmacy benefit rules reach qualifying self-funded employee plans and members living outside Illinois. Non-governmental self-funded multiemployer plans, workers' compensation, specified federal and Medicare plans, TRICARE, and certain Medicare-Medicaid programs are excluded. The group insurance exemption also extends to other health benefit plans through state regulation. Sponsors of federally covered self-funded employee plans are not classified as insurers; this alone does not exclude their plans. Unless another date applies, contract requirements cover agreements entered, renewed, or amended beginning January 1, 2026. That date also governs the specified drug-plan changes and pharmacy benefit managers contracted with Medicaid managed care entities.
More treatment options at Illinois pharmacies
Actively licensed Illinois pharmacists can give medicines through the nose within the pharmacy practice settings listed in law. Trained technicians and student pharmacists can give COVID-19 treatments using the method allowed by the FDA authorization, approval, or license. Their authority is no longer limited to oral, under-the-skin, or muscle delivery. A trained supervising pharmacist must be immediately available, and staff must meet practical training, CPR, safety, and recordkeeping requirements.
Illinois strengthens expert guidance on vaccines
Illinois must publish disease-prevention guidelines grounded in evidence, safety, disease burden, effectiveness, costs, and practical use. Guidelines must identify recommended populations, precautions, and known adverse events, and cannot significantly depart from accepted evidence-based practice. A Governor-appointed advisory committee of up to 21 experts provides recommendations that the Department must publish and the Director must consider. If its chair finds that consideration inadequate, a two-thirds vote can replace published guidelines for at least six months. When the Director is not a licensed physician, the Medical Director can issue missing or supplemental guidance and oversees specified health policies.
Drug middlemen can seek limited refunds
Beginning July 1, 2025, pharmacy benefit managers can request refunds for factual, calculation, or Illinois-law interpretation errors. They must submit a revised report and explanation by December 1 of the year the report was due. The Director may approve eligible refunds, but cash refunds are unavailable for overpayments below $100. Cash refunds also require enough fund money after the required pharmacy-grant transfer. Refunds are barred for payments tied to plans that Illinois law makes subject to these pharmacy benefit rules.
Health plans gain drug pricing oversight
Contracts with pharmacy benefit managers must require maximum allowable cost price updates at least every 7 calendar days. Network pharmacies gain real-time list access, clear pricing criteria, and an appeals process with 14-day filing and response windows. Successful pricing appeals require retroactive corrections. Insurers and plan sponsors can conduct annual compliance audits and request actual pharmacy payment amounts. Contracts must also provide required notices about manufacturer payments and access to specified pricing and rebate records.
Retail groups gain development funding access
Retail associations can receive state grants, loans, or contracts for municipal development projects through the DCEO Projects Fund. They join existing local-government, economic-development, and nonprofit recipient groups. Funding requires an appropriation, and project purposes must follow the terms of the gift, grant, or award.
Drug middlemen pay resident-based state fees
Beginning July 1, 2025, pharmacy benefit manager fees are calculated using covered Illinois residents, not the broader membership count. Annual payments begin September 1, 2025, at $15 per resident or another amount set by rule. Initial resident counts are due August 1, 2025; certain reports need revision by December 1, 2025. Any resulting 2025 shortfall is due January 2, 2026; later counts come from annual reports. Payments are required to do business in Illinois and enter the Prescription Drug Affordability Fund. The first $25 million annually goes to the DCEO Projects Fund for pharmacy grants; the rest goes to general revenue.
Public employee pharmacy protections have limits
Beginning July 1, 2025, self-funded state and local government plans receive these pharmacy protections only through their organizing state law. That law must incorporate the pharmacy benefit rules by reference. For joint self-insurance pools, this test applies separately to each member government. Qualifying governmental sponsors, joint pools, and public agencies also gain recognition as plan sponsors with rights under these rules.
Sponsors & Cosponsors
Sponsors
There is no primary sponsor on record.
Cosponsors
Bob Morgan
Democratic • House
Cristina Castro
Democratic • Senate
David Koehler
Democratic • Senate
Graciela Guzmán
Democratic • Senate
Janet Yang Rohr
Democratic • House
Joyce Mason
Democratic • House
Julie A. Morrison
Democratic • Senate
Laura Faver Dias
Democratic • House
Mattie Hunter
Democratic • Senate
Roll Call Votes
Senate vote • 10/30/2025
Third Reading - Passed;
Yes: 40 • No: 18
Senate vote • 10/29/2025
Do Pass Executive;
Yes: 9 • No: 4
House vote • 10/28/2025
Third Reading - Short Debate - Passed
Yes: 74 • No: 38
House vote • 10/28/2025
Approved for Consideration Rules Committee;
Yes: 5 • No: 0
House vote • 10/28/2025
House Floor Amendment No. 2 Recommends Be Adopted Rules Committee;
Yes: 5 • No: 0
House vote • 10/28/2025
House Floor Amendment No. 1 Recommends Be Adopted Health Care Availability & Accessibility Committee;
Yes: 8 • No: 5
House vote • 3/12/2025
Do Pass / Short Debate Executive Committee;
Yes: 12 • No: 0
Actions Timeline
Public Act . . . . . . . . . 104-0439
12/2/2025HouseEffective Date January 1, 2026; some provisions
12/2/2025HouseEffective Date December 2, 2025; some provisions
12/2/2025HouseGovernor Approved
12/2/2025HouseAdded as Alternate Co-Sponsor Sen. Julie A. Morrison
12/1/2025SenateSent to the Governor
11/21/2025HouseAdded as Alternate Co-Sponsor Sen. Graciela Guzmán
10/31/2025SenateAdded as Alternate Co-Sponsor Sen. Mattie Hunter
10/30/2025SenateAdded as Alternate Co-Sponsor Sen. Cristina Castro
10/30/2025SenatePassed Both Houses
10/30/2025HouseThird Reading - Passed; 040-018-000
10/30/2025Senate3/5 Vote Required
10/30/2025SenateAdded Co-Sponsor Rep. Joyce Mason
10/30/2025HousePlaced on Calendar Order of 3rd Reading October 30, 2025
10/29/2025SenateSecond Reading
10/29/2025SenatePlaced on Calendar Order of 2nd Reading
10/29/2025SenateDo Pass Executive; 009-004-000
10/29/2025SenateAlternate Chief Sponsor Changed to Sen. David Koehler
10/29/2025SenateWaive Posting Notice
10/29/2025SenateAssigned to Executive
10/29/2025SenateReferred to Assignments
10/28/2025SenateFirst Reading
10/28/2025SenateChief Senate Sponsor Sen. Don Harmon
10/28/2025SenatePlaced on Calendar Order of First Reading
10/28/2025SenateArrive in Senate
10/28/2025Senate
Bill Text
Engrossed
Enrolled
House Amendment 1
House Amendment 2
Introduced
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