HB 4548

Abstract

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, 2024. House Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Provides that "rebate aggregator" means a person or entity that negotiates rebates, discounts, or other fees attributable to usage by covered individuals (instead of negotiates rebates) with drug manufacturers on behalf of pharmacy benefit managers or their clients and may also be involved in contracts that entitle the rebate aggregator or its client to receive rebates, discounts, or other fees attributable to usage (instead of receive rebates) by covered individuals from drug manufacturers based on drug utilization or administration. Provides that the annual report by a pharmacy benefit manager that provides services for a health benefit plan must include the net cost of the drugs covered by the health benefit plan. Excludes Medicaid managed care organizations and employee welfare benefit plans subject to the federal Employee Retirement Income Security Act of 1974 from the definitions of "health benefit plan", "pharmacy benefit manager", and "third-party payer". Effective July 1, 2024.