IllinoisSB1390104th General Assembly (2025–2026)Senate

DHFS-MCO-PBM-CONTRACTS

Sponsored By: David Koehler (Democratic)

In Committee

Summary

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, 2027, 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.

assignmentsinsurance

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Bill Overview

No Economic Impacts Identified for this Bill

Sponsors & Cosponsors

Sponsor

  • David Koehler

    Democratic • Senate

Cosponsors

  • Dale Fowler

    Republican • Senate

  • Meg Loughran Cappel

    Democratic • Senate

  • Steve McClure

    Republican • Senate

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. Senate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments

    6/2/2025Senate
  2. Rule 3-9(a) / Re-referred to Assignments

    6/2/2025Senate
  3. Rule 2-10 Committee/3rd Reading Deadline Established As June 1, 2025

    5/23/2025Senate
  4. Rule 2-10 Committee/3rd Reading Deadline Established As May 23, 2025

    5/9/2025Senate
  5. Rule 2-10 Committee/3rd Reading Deadline Established As May 9, 2025

    4/11/2025Senate
  6. Rule 2-10 Committee Deadline Established As April 11, 2025

    4/4/2025Senate
  7. Added as Chief Co-Sponsor Sen. Dale Fowler

    4/2/2025Senate
  8. Rule 2-10 Committee Deadline Established As April 4, 2025

    3/21/2025Senate
  9. Postponed - Insurance

    3/19/2025Senate
  10. Senate Committee Amendment No. 1 Postponed - Insurance

    3/19/2025Senate
  11. Senate Committee Amendment No. 1 Assignments Refers to Insurance

    3/18/2025Senate
  12. Senate Committee Amendment No. 1 Referred to Assignments

    3/17/2025Senate
  13. Senate Committee Amendment No. 1 Filed with Secretary by Sen. David Koehler

    3/17/2025Senate
  14. Assigned to Insurance

    3/12/2025Senate
  15. Added as Co-Sponsor Sen. Meg Loughran Cappel

    2/26/2025Senate
  16. Added as Co-Sponsor Sen. Steve McClure

    2/4/2025Senate
  17. Referred to Assignments

    1/29/2025Senate
  18. First Reading

    1/29/2025Senate
  19. Filed with Secretary by Sen. David Koehler

    1/29/2025Senate

Bill Text

  • Introduced

  • Senate Amendment 1

Related Bills

Back to State Legislation