All Roll Calls
Yes: 153 • No: 65
IllinoisHB0767104th General Assembly (2025–2026)HouseWALLET
REGULATION-TECH
Sponsored By: Bob Morgan (Democratic)
Became Law
executiveassignments
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Bill Overview
Analyzed Economic Effects
19 provisions identified: 16 benefits, 0 costs, 3 mixed.
No-cost care when network lacks it
If no in‑network provider can deliver a covered service, your plan must cover an out‑of‑network provider. You pay no deductible, copay, or coinsurance for that service. This protects you from surprise out‑of‑network bills.
Extra safeguards for seniors’ policies
If someone over 65 has a health care power of attorney or reduced capacity, their agent must sign any new or changed health policy. The agreement must be in writing. This protects older adults in insurance transactions.
Stronger insurance sales rules for seniors
Sellers cannot pressure people over 65 or nursing‑home residents to buy health insurance. They must tell the person to review current coverage, discuss changes with a family member or advisor, then wait 48 hours before making changes. They must give a phone number for questions and let the person opt out of future contacts.
Lower drug costs and more pharmacy choice
The law caps what you pay at the counter at the smallest of four amounts: your cost share, the cash price, a no‑cost voucher price, or a discounted plan price. PBMs cannot mark up prices between what a plan pays and what a pharmacy gets. PBMs and insurers cannot steer you to certain pharmacies, though older contracts signed before the law can run until they end. They also cannot misuse a “specialty drug” label to limit where you fill. Pharmacists are free to tell you if a cheaper option or lower cash price is available.
More vaccines and tests at pharmacies
Pharmacists can give many vaccines and injections to people age 3 and older, follow standing orders, and must report shots to the state system. Pharmacists may order and give some COVID‑19 treatments and point‑of‑care tests for certain respiratory illnesses, with training and records required. Trained technicians and student pharmacists can give certain vaccines and some COVID‑19 treatments under a supervising pharmacist. Technician and student authority took effect June 7, 2024. The broader pharmacist authorities took effect November 26, 2024.
Pharmacist care covered like doctors
Vaccines ordered and given by pharmacists must be paid at least the same as when doctors give them. Tests, screening, and treatment ordered by a pharmacist are covered like doctor, nurse practitioner, or physician assistant services. The pharmacist must act within their license. These rules took effect November 26, 2024.
Fair treatment rules for pharmacies
PBMs and payors cannot discriminate against pharmacies or pharmacists on participation, referrals, reimbursement, or indemnity when they follow the law. Contracts cannot penalize 340B pharmacies with lower pay, extra fees, or network limits because they use 340B drugs. PBMs cannot cancel or refuse to renew a contract just because a pharmacist reports suspected legal violations. The non‑discrimination rule on participation and reimbursement took effect November 26, 2024.
Grants to support small pharmacies
When funded, the state grants money to a statewide pharmacy association to help eligible pharmacies keep access to care. Eligible groups include critical‑access and small‑chain pharmacies, those in small counties or underserved areas, high‑Medicaid pharmacies, and pharmacies in high‑poverty or long‑distance tracts. Each fiscal year, awards are split equally among eligible applicants after administrative costs, and each pharmacy can receive only one award per year.
Immunization committee and state guidelines
The Public Health Director appoints an Immunization Advisory Committee and must publish evidence‑based State Guidelines for vaccines and countermeasures. The Committee’s advice is posted online, and with a two‑thirds vote it can override and republish guidelines for at least six months. The law defines immunizations and medical countermeasures and sets committee size and terms.
Public health leadership qualifications
If the Public Health Director is not a physician, the Department must appoint a licensed physician as Medical Director. A non‑physician Director must have at least five years of public health admin experience and the required graduate education. The Assistant Director must have administrative experience in public health work.
Fairer PBM MAC prices and appeals
PBMs must update maximum allowable cost (MAC) prices at least every seven days and give pharmacies access to MAC lists. Pharmacies have 14 days after a fill to appeal underpaid MAC claims, and PBMs must respond in 14 days. If an appeal is upheld, payments are fixed retroactively for similar pharmacies. PBMs can only MAC‑list drugs that are equivalent, available statewide from wholesalers, and not obsolete.
PBMs must pass through rebates
PBMs must remit at least 100% of manufacturer payments to the plan sponsor, covered person, or employer. Contracts must allow annual audits of PBM rebates and fees, with results sent to the state. Plan sponsors can audit PBMs yearly and must get full rebate details. Insurers or plan sponsors can see actual amounts PBMs pay pharmacies. PBMs must disclose any manufacturer payments tied to dispense‑as‑written when generics or biosimilars are available.
Stronger PBM reporting and fines
Starting January 1, 2026, PBMs must file detailed annual reports by September 1 with drug, price, rebate, payment, and contract data. A public summary is required; the full report is confidential. The state can fine PBMs up to $10,000 per day, per offense for report failures and must post adverse decisions online. PBMs can request short filing extensions, and remain responsible even if affiliates do work.
Stop discriminatory 340B contract terms
Any contract clause that violates 340B nondiscrimination rules is void if the contract was entered, changed, or renewed after July 1, 2022. Those terms cannot be enforced.
New fund for local development projects
The state created the DCEO Projects Fund to hold public or private money for development projects. If money is appropriated, the Department can make grants or loans and contracts with local governments, development groups, retail associations, and nonprofits. Projects must follow the terms of the funding and can include efforts to cut food insecurity in cities and rural areas.
Stronger coverage for preventive care
Illinois health plans must cover USPSTF A/B services, ACIP vaccines, and HRSA preventive care with no cost-sharing. Coverage starts for plan years beginning one year after a recommendation. If a State Guideline reinstates a vaccine that ACIP reduced, coverage starts within 15 business days. Insurers can charge cost-sharing for the office visit if the preventive service is billed separately. They cannot deny preventive care based on recorded sex or gender identity. High‑deductible HSA plans keep federal HSA rules.
PBM registration and new payments
Starting July 1, 2025, PBMs must register with the state; fees are up to $500 and renew every two years. By August 1, 2025, PBMs must report Illinois covered lives, and by September 1, 2025 pay $15 per covered person; payments are due each September 1 after. The Prescription Drug Affordability Fund begins July 1, 2025. Each year, the first $25,000,000 goes to a pharmacy grants fund; the rest goes to General Revenue. PBMs can request overpayment refunds by December 1; cash refunds require at least $100 and enough money in the Fund.
Free COVID, flu, and RSV shots
For policies amended, issued, or renewed on or after January 1, 2026, COVID‑19, flu, and RSV vaccines are covered with no cost-sharing. The vaccine must be FDA‑authorized or licensed and follow state or ACIP guidance. If contracted vaccinators are unavailable, plans must still cover the shot and its fee with no cost-sharing. HSA high‑deductible plan rules stay the same.
When these PBM rules apply
PBM contract rules apply to contracts entered into or renewed on or after July 1, 2022. Group and individual policies amended, issued, or renewed on or after July 1, 2020 are also covered. Some definitions and changes take effect on July 1, 2025 or January 1, 2026, as the law specifies.
Sponsors & Cosponsors
Sponsor
Bob Morgan
Democratic • House
Cosponsors
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
House Floor Amendment No. 2 Recommends Be Adopted Rules Committee;
Yes: 5 • No: 0
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. 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