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91_SB1162
LRB9103414JSpc
1 AN ACT to amend the Health Maintenance Organization Act
2 by adding Section 2-3.2.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Maintenance Organization Act is
6 amended by adding Section 2-3.2 as follows:
7 (215 ILCS 125/2-3.2 new)
8 Sec. 2-3.2. Pharmacy providers.
9 (a) Before entering into an agreement with pharmacy
10 providers, an organization must establish terms and
11 conditions that must be met by pharmacy providers desiring to
12 contract with the organization. The terms and conditions may
13 not unreasonably discriminate against a pharmacy provider.
14 Difference in prices among pharmacy providers produced by a
15 process of individual negotiation and difference in prices
16 among pharmacy providers in different geographical areas does
17 not constitute unreasonable discrimination. An organization
18 may not refuse to contract with a pharmacy provider that
19 meets the terms and conditions established by the
20 organization.
21 (b) An organization shall apply the same coinsurance,
22 copayment, and deductible factors to all drug prescriptions
23 filled by a pharmacy provider that participates in the
24 organization's network if the provider meets the terms and
25 conditions established under subsection (a). If a pharmacy
26 provider rejects the terms and conditions established under
27 subsection (a), the organization may offer other terms and
28 conditions necessary to comply with network adequacy
29 requirements. Nothing in this subsection, however, prohibits
30 an organization from applying different coinsurance,
31 copayment, and deductible factors between brand name drugs
-2- LRB9103414JSpc
1 and generic drugs when a generic equivalent exists for the
2 brand name drug.
3 (c) An organization may not set a limit on the quantity
4 of drugs that an enrollee may obtain at one time with a
5 prescription unless the limit is applied uniformly to all
6 pharmacy providers in the organization's network.
7 (d) An organization may not require a provider to change
8 an enrollee's maintenance drug unless the enrollee and
9 provider agree to the change. An organization that changes
10 an enrollee's maintenance drug without the consent of the
11 enrollee and provider shall be liable for any damages
12 resulting from the change. As used in this subsection,
13 "maintenance drug" means a drug prescribed by a person
14 authorized to prescribe drugs and used to treat a medical
15 condition for a period of more than 30 days.