IllinoisHB1159104th General Assembly (2025–2026)House

INS-PHARMACY BENEFIT MANAGERS

Sponsored By: Thaddeus Jones (Democratic)

In Committee

Summary

Amends the Illinois Insurance Code. Defines "health benefit plan" and other terms. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf is prohibited from conducting spread pricing, from steering a covered individual, and from limiting a covered individual's access to prescription drugs from a pharmacy or pharmacist enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area by unreasonably designating the covered prescription drugs as a specialty drug. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf must remit 100% of rebates and fees to the health benefit plan sponsor, consumer, or employer. Provides that a pharmacy benefit manager may 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. Provides that a contract between a pharmacy benefit manager and an insurer or health benefit plan sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at least once per calendar year of the rebate and fee records remitted from a pharmacy benefit manager or its contracted party to a health benefit plan. Provides that provisions concerning pharmacy benefit manager contracts apply to any health benefit plan (instead of any group or individual policy of accident and health insurance or managed care plan) that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020. Requires a pharmacy benefit manager to submit an annual report that includes specified information concerning prescription drugs. Makes other changes. Amends the Freedom of Information Act to make a conforming change. Effective July 1, 2025.

health care availability & accessibility

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Bill Overview

No Economic Impacts Identified for this Bill

Sponsors & Cosponsors

Sponsor

  • Thaddeus Jones

    Democratic • House

Cosponsors

  • Janet Yang Rohr

    Democratic • House

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. Added Co-Sponsor Rep. Janet Yang Rohr

    4/10/2025House
  2. Rule 19(a) / Re-referred to Rules Committee

    3/21/2025House
  3. To Pharmacy Benefit Manager Subcommittee

    2/18/2025House
  4. Assigned to Health Care Availability & Accessibility Committee

    2/11/2025House
  5. Referred to Rules Committee

    1/9/2025House
  6. First Reading

    1/9/2025House
  7. Prefiled with Clerk by Rep. Thaddeus Jones

    1/6/2025House

Bill Text

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