HB3794 - 104th General Assembly
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| 1 | AN ACT concerning prescription drugs. | |||||||||||||||||||||||
| 2 | Be it enacted by the People of the State of Illinois, | |||||||||||||||||||||||
| 3 | represented in the General Assembly: | |||||||||||||||||||||||
| 4 | Section 5. The Freedom of Information Act is amended by | |||||||||||||||||||||||
| 5 | changing Section 7.5 as follows: | |||||||||||||||||||||||
| 6 | (5 ILCS 140/7.5) | |||||||||||||||||||||||
| 7 | Sec. 7.5. Statutory exemptions. To the extent provided for | |||||||||||||||||||||||
| 8 | by the statutes referenced below, the following shall be | |||||||||||||||||||||||
| 9 | exempt from inspection and copying: | |||||||||||||||||||||||
| 10 | (a) All information determined to be confidential | |||||||||||||||||||||||
| 11 | under Section 4002 of the Technology Advancement and | |||||||||||||||||||||||
| 12 | Development Act. | |||||||||||||||||||||||
| 13 | (b) Library circulation and order records identifying | |||||||||||||||||||||||
| 14 | library users with specific materials under the Library | |||||||||||||||||||||||
| 15 | Records Confidentiality Act. | |||||||||||||||||||||||
| 16 | (c) Applications, related documents, and medical | |||||||||||||||||||||||
| 17 | records received by the Experimental Organ Transplantation | |||||||||||||||||||||||
| 18 | Procedures Board and any and all documents or other | |||||||||||||||||||||||
| 19 | records prepared by the Experimental Organ Transplantation | |||||||||||||||||||||||
| 20 | Procedures Board or its staff relating to applications it | |||||||||||||||||||||||
| 21 | has received. | |||||||||||||||||||||||
| 22 | (d) Information and records held by the Department of | |||||||||||||||||||||||
| 23 | Public Health and its authorized representatives relating | |||||||||||||||||||||||
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| 1 | to known or suspected cases of sexually transmitted | ||||||
| 2 | infection or any information the disclosure of which is | ||||||
| 3 | restricted under the Illinois Sexually Transmitted | ||||||
| 4 | Infection Control Act. | ||||||
| 5 | (e) Information the disclosure of which is exempted | ||||||
| 6 | under Section 30 of the Radon Industry Licensing Act. | ||||||
| 7 | (f) Firm performance evaluations under Section 55 of | ||||||
| 8 | the Architectural, Engineering, and Land Surveying | ||||||
| 9 | Qualifications Based Selection Act. | ||||||
| 10 | (g) Information the disclosure of which is restricted | ||||||
| 11 | and exempted under Section 50 of the Illinois Prepaid | ||||||
| 12 | Tuition Act. | ||||||
| 13 | (h) Information the disclosure of which is exempted | ||||||
| 14 | under the State Officials and Employees Ethics Act, and | ||||||
| 15 | records of any lawfully created State or local inspector | ||||||
| 16 | general's office that would be exempt if created or | ||||||
| 17 | obtained by an Executive Inspector General's office under | ||||||
| 18 | that Act. | ||||||
| 19 | (i) Information contained in a local emergency energy | ||||||
| 20 | plan submitted to a municipality in accordance with a | ||||||
| 21 | local emergency energy plan ordinance that is adopted | ||||||
| 22 | under Section 11-21.5-5 of the Illinois Municipal Code. | ||||||
| 23 | (j) Information and data concerning the distribution | ||||||
| 24 | of surcharge moneys collected and remitted by carriers | ||||||
| 25 | under the Emergency Telephone System Act. | ||||||
| 26 | (k) Law enforcement officer identification information | ||||||
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| 1 | or driver identification information compiled by a law | ||||||
| 2 | enforcement agency or the Department of Transportation | ||||||
| 3 | under Section 11-212 of the Illinois Vehicle Code. | ||||||
| 4 | (l) Records and information provided to a residential | ||||||
| 5 | health care facility resident sexual assault and death | ||||||
| 6 | review team or the Executive Council under the Abuse | ||||||
| 7 | Prevention Review Team Act. | ||||||
| 8 | (m) Information provided to the predatory lending | ||||||
| 9 | database created pursuant to Article 3 of the Residential | ||||||
| 10 | Real Property Disclosure Act, except to the extent | ||||||
| 11 | authorized under that Article. | ||||||
| 12 | (n) Defense budgets and petitions for certification of | ||||||
| 13 | compensation and expenses for court appointed trial | ||||||
| 14 | counsel as provided under Sections 10 and 15 of the | ||||||
| 15 | Capital Crimes Litigation Act (repealed). This subsection | ||||||
| 16 | (n) shall apply until the conclusion of the trial of the | ||||||
| 17 | case, even if the prosecution chooses not to pursue the | ||||||
| 18 | death penalty prior to trial or sentencing. | ||||||
| 19 | (o) Information that is prohibited from being | ||||||
| 20 | disclosed under Section 4 of the Illinois Health and | ||||||
| 21 | Hazardous Substances Registry Act. | ||||||
| 22 | (p) Security portions of system safety program plans, | ||||||
| 23 | investigation reports, surveys, schedules, lists, data, or | ||||||
| 24 | information compiled, collected, or prepared by or for the | ||||||
| 25 | Department of Transportation under Sections 2705-300 and | ||||||
| 26 | 2705-616 of the Department of Transportation Law of the | ||||||
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| 1 | Civil Administrative Code of Illinois, the Regional | ||||||
| 2 | Transportation Authority under Section 2.11 of the | ||||||
| 3 | Regional Transportation Authority Act, or the St. Clair | ||||||
| 4 | County Transit District under the Bi-State Transit Safety | ||||||
| 5 | Act (repealed). | ||||||
| 6 | (q) Information prohibited from being disclosed by the | ||||||
| 7 | Personnel Record Review Act. | ||||||
| 8 | (r) Information prohibited from being disclosed by the | ||||||
| 9 | Illinois School Student Records Act. | ||||||
| 10 | (s) Information the disclosure of which is restricted | ||||||
| 11 | under Section 5-108 of the Public Utilities Act. | ||||||
| 12 | (t) (Blank). | ||||||
| 13 | (u) Records and information provided to an independent | ||||||
| 14 | team of experts under the Developmental Disability and | ||||||
| 15 | Mental Health Safety Act (also known as Brian's Law). | ||||||
| 16 | (v) Names and information of people who have applied | ||||||
| 17 | for or received Firearm Owner's Identification Cards under | ||||||
| 18 | the Firearm Owners Identification Card Act or applied for | ||||||
| 19 | or received a concealed carry license under the Firearm | ||||||
| 20 | Concealed Carry Act, unless otherwise authorized by the | ||||||
| 21 | Firearm Concealed Carry Act; and databases under the | ||||||
| 22 | Firearm Concealed Carry Act, records of the Concealed | ||||||
| 23 | Carry Licensing Review Board under the Firearm Concealed | ||||||
| 24 | Carry Act, and law enforcement agency objections under the | ||||||
| 25 | Firearm Concealed Carry Act. | ||||||
| 26 | (v-5) Records of the Firearm Owner's Identification | ||||||
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| 1 | Card Review Board that are exempted from disclosure under | ||||||
| 2 | Section 10 of the Firearm Owners Identification Card Act. | ||||||
| 3 | (w) Personally identifiable information which is | ||||||
| 4 | exempted from disclosure under subsection (g) of Section | ||||||
| 5 | 19.1 of the Toll Highway Act. | ||||||
| 6 | (x) Information which is exempted from disclosure | ||||||
| 7 | under Section 5-1014.3 of the Counties Code or Section | ||||||
| 8 | 8-11-21 of the Illinois Municipal Code. | ||||||
| 9 | (y) Confidential information under the Adult | ||||||
| 10 | Protective Services Act and its predecessor enabling | ||||||
| 11 | statute, the Elder Abuse and Neglect Act, including | ||||||
| 12 | information about the identity and administrative finding | ||||||
| 13 | against any caregiver of a verified and substantiated | ||||||
| 14 | decision of abuse, neglect, or financial exploitation of | ||||||
| 15 | an eligible adult maintained in the Registry established | ||||||
| 16 | under Section 7.5 of the Adult Protective Services Act. | ||||||
| 17 | (z) Records and information provided to a fatality | ||||||
| 18 | review team or the Illinois Fatality Review Team Advisory | ||||||
| 19 | Council under Section 15 of the Adult Protective Services | ||||||
| 20 | Act. | ||||||
| 21 | (aa) Information which is exempted from disclosure | ||||||
| 22 | under Section 2.37 of the Wildlife Code. | ||||||
| 23 | (bb) Information which is or was prohibited from | ||||||
| 24 | disclosure by the Juvenile Court Act of 1987. | ||||||
| 25 | (cc) Recordings made under the Law Enforcement | ||||||
| 26 | Officer-Worn Body Camera Act, except to the extent | ||||||
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| 1 | authorized under that Act. | ||||||
| 2 | (dd) Information that is prohibited from being | ||||||
| 3 | disclosed under Section 45 of the Condominium and Common | ||||||
| 4 | Interest Community Ombudsperson Act. | ||||||
| 5 | (ee) Information that is exempted from disclosure | ||||||
| 6 | under Section 30.1 of the Pharmacy Practice Act. | ||||||
| 7 | (ff) Information that is exempted from disclosure | ||||||
| 8 | under the Revised Uniform Unclaimed Property Act. | ||||||
| 9 | (gg) Information that is prohibited from being | ||||||
| 10 | disclosed under Section 7-603.5 of the Illinois Vehicle | ||||||
| 11 | Code. | ||||||
| 12 | (hh) Records that are exempt from disclosure under | ||||||
| 13 | Section 1A-16.7 of the Election Code. | ||||||
| 14 | (ii) Information which is exempted from disclosure | ||||||
| 15 | under Section 2505-800 of the Department of Revenue Law of | ||||||
| 16 | the Civil Administrative Code of Illinois. | ||||||
| 17 | (jj) Information and reports that are required to be | ||||||
| 18 | submitted to the Department of Labor by registering day | ||||||
| 19 | and temporary labor service agencies but are exempt from | ||||||
| 20 | disclosure under subsection (a-1) of Section 45 of the Day | ||||||
| 21 | and Temporary Labor Services Act. | ||||||
| 22 | (kk) Information prohibited from disclosure under the | ||||||
| 23 | Seizure and Forfeiture Reporting Act. | ||||||
| 24 | (ll) Information the disclosure of which is restricted | ||||||
| 25 | and exempted under Section 5-30.8 of the Illinois Public | ||||||
| 26 | Aid Code. | ||||||
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| 1 | (mm) Records that are exempt from disclosure under | ||||||
| 2 | Section 4.2 of the Crime Victims Compensation Act. | ||||||
| 3 | (nn) Information that is exempt from disclosure under | ||||||
| 4 | Section 70 of the Higher Education Student Assistance Act. | ||||||
| 5 | (oo) Communications, notes, records, and reports | ||||||
| 6 | arising out of a peer support counseling session | ||||||
| 7 | prohibited from disclosure under the First Responders | ||||||
| 8 | Suicide Prevention Act. | ||||||
| 9 | (pp) Names and all identifying information relating to | ||||||
| 10 | an employee of an emergency services provider or law | ||||||
| 11 | enforcement agency under the First Responders Suicide | ||||||
| 12 | Prevention Act. | ||||||
| 13 | (qq) Information and records held by the Department of | ||||||
| 14 | Public Health and its authorized representatives collected | ||||||
| 15 | under the Reproductive Health Act. | ||||||
| 16 | (rr) Information that is exempt from disclosure under | ||||||
| 17 | the Cannabis Regulation and Tax Act. | ||||||
| 18 | (ss) Data reported by an employer to the Department of | ||||||
| 19 | Human Rights pursuant to Section 2-108 of the Illinois | ||||||
| 20 | Human Rights Act. | ||||||
| 21 | (tt) Recordings made under the Children's Advocacy | ||||||
| 22 | Center Act, except to the extent authorized under that | ||||||
| 23 | Act. | ||||||
| 24 | (uu) Information that is exempt from disclosure under | ||||||
| 25 | Section 50 of the Sexual Assault Evidence Submission Act. | ||||||
| 26 | (vv) Information that is exempt from disclosure under | ||||||
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| 1 | subsections (f) and (j) of Section 5-36 of the Illinois | ||||||
| 2 | Public Aid Code. | ||||||
| 3 | (ww) Information that is exempt from disclosure under | ||||||
| 4 | Section 16.8 of the State Treasurer Act. | ||||||
| 5 | (xx) Information that is exempt from disclosure or | ||||||
| 6 | information that shall not be made public under the | ||||||
| 7 | Illinois Insurance Code. | ||||||
| 8 | (yy) Information prohibited from being disclosed under | ||||||
| 9 | the Illinois Educational Labor Relations Act. | ||||||
| 10 | (zz) Information prohibited from being disclosed under | ||||||
| 11 | the Illinois Public Labor Relations Act. | ||||||
| 12 | (aaa) Information prohibited from being disclosed | ||||||
| 13 | under Section 1-167 of the Illinois Pension Code. | ||||||
| 14 | (bbb) Information that is prohibited from disclosure | ||||||
| 15 | by the Illinois Police Training Act and the Illinois State | ||||||
| 16 | Police Act. | ||||||
| 17 | (ccc) Records exempt from disclosure under Section | ||||||
| 18 | 2605-304 of the Illinois State Police Law of the Civil | ||||||
| 19 | Administrative Code of Illinois. | ||||||
| 20 | (ddd) Information prohibited from being disclosed | ||||||
| 21 | under Section 35 of the Address Confidentiality for | ||||||
| 22 | Victims of Domestic Violence, Sexual Assault, Human | ||||||
| 23 | Trafficking, or Stalking Act. | ||||||
| 24 | (eee) Information prohibited from being disclosed | ||||||
| 25 | under subsection (b) of Section 75 of the Domestic | ||||||
| 26 | Violence Fatality Review Act. | ||||||
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| 1 | (fff) Images from cameras under the Expressway Camera | ||||||
| 2 | Act. This subsection (fff) is inoperative on and after | ||||||
| 3 | July 1, 2025. | ||||||
| 4 | (ggg) Information prohibited from disclosure under | ||||||
| 5 | paragraph (3) of subsection (a) of Section 14 of the Nurse | ||||||
| 6 | Agency Licensing Act. | ||||||
| 7 | (hhh) Information submitted to the Illinois State | ||||||
| 8 | Police in an affidavit or application for an assault | ||||||
| 9 | weapon endorsement, assault weapon attachment endorsement, | ||||||
| 10 | .50 caliber rifle endorsement, or .50 caliber cartridge | ||||||
| 11 | endorsement under the Firearm Owners Identification Card | ||||||
| 12 | Act. | ||||||
| 13 | (iii) Data exempt from disclosure under Section 50 of | ||||||
| 14 | the School Safety Drill Act. | ||||||
| 15 | (jjj) Information exempt from disclosure under Section | ||||||
| 16 | 30 of the Insurance Data Security Law. | ||||||
| 17 | (kkk) Confidential business information prohibited | ||||||
| 18 | from disclosure under Section 45 of the Paint Stewardship | ||||||
| 19 | Act. | ||||||
| 20 | (lll) Data exempt from disclosure under Section | ||||||
| 21 | 2-3.196 of the School Code. | ||||||
| 22 | (mmm) Information prohibited from being disclosed | ||||||
| 23 | under subsection (e) of Section 1-129 of the Illinois | ||||||
| 24 | Power Agency Act. | ||||||
| 25 | (nnn) Materials received by the Department of Commerce | ||||||
| 26 | and Economic Opportunity that are confidential under the | ||||||
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| 1 | Music and Musicians Tax Credit and Jobs Act. | ||||||
| 2 | (ooo) (nnn) Data or information provided pursuant to | ||||||
| 3 | Section 20 of the Statewide Recycling Needs and Assessment | ||||||
| 4 | Act. | ||||||
| 5 | (ppp) (nnn) Information that is exempt from disclosure | ||||||
| 6 | under Section 28-11 of the Lawful Health Care Activity | ||||||
| 7 | Act. | ||||||
| 8 | (qqq) (nnn) Information that is exempt from disclosure | ||||||
| 9 | under Section 7-101 of the Illinois Human Rights Act. | ||||||
| 10 | (rrr) (mmm) Information prohibited from being | ||||||
| 11 | disclosed under Section 4-2 of the Uniform Money | ||||||
| 12 | Transmission Modernization Act. | ||||||
| 13 | (sss) (nnn) Information exempt from disclosure under | ||||||
| 14 | Section 40 of the Student-Athlete Endorsement Rights Act. | ||||||
| 15 | (ttt) Information prohibited from being disclosed | ||||||
| 16 | under subsection (g-5) of Section 513b1 of the Illinois | ||||||
| 17 | Insurance Code. | ||||||
| 18 | (Source: P.A. 102-36, eff. 6-25-21; 102-237, eff. 1-1-22; | ||||||
| 19 | 102-292, eff. 1-1-22; 102-520, eff. 8-20-21; 102-559, eff. | ||||||
| 20 | 8-20-21; 102-813, eff. 5-13-22; 102-946, eff. 7-1-22; | ||||||
| 21 | 102-1042, eff. 6-3-22; 102-1116, eff. 1-10-23; 103-8, eff. | ||||||
| 22 | 6-7-23; 103-34, eff. 6-9-23; 103-142, eff. 1-1-24; 103-372, | ||||||
| 23 | eff. 1-1-24; 103-472, eff. 8-1-24; 103-508, eff. 8-4-23; | ||||||
| 24 | 103-580, eff. 12-8-23; 103-592, eff. 6-7-24; 103-605, eff. | ||||||
| 25 | 7-1-24; 103-636, eff. 7-1-24; 103-724, eff. 1-1-25; 103-786, | ||||||
| 26 | eff. 8-7-24; 103-859, eff. 8-9-24; 103-991, eff. 8-9-24; | ||||||
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| 1 | 103-1049, eff. 8-9-24; revised 11-26-24.) | ||||||
| 2 | Section 10. The Illinois Insurance Code is amended by | ||||||
| 3 | changing Section 513b1 as follows: | ||||||
| 4 | (215 ILCS 5/513b1) | ||||||
| 5 | Sec. 513b1. Pharmacy benefit manager contracts. | ||||||
| 6 | (a) As used in this Section: | ||||||
| 7 | "340B drug discount program" means the program established | ||||||
| 8 | under Section 340B of the federal Public Health Service Act, | ||||||
| 9 | 42 U.S.C. 256b. | ||||||
| 10 | "340B entity" means a covered entity as defined in 42 | ||||||
| 11 | U.S.C. 256b(a)(4) authorized to participate in the 340B drug | ||||||
| 12 | discount program. | ||||||
| 13 | "340B pharmacy" means any pharmacy used to dispense 340B | ||||||
| 14 | drugs for a covered entity, whether entity-owned or external. | ||||||
| 15 | "Biological product" has the meaning ascribed to that term | ||||||
| 16 | in Section 19.5 of the Pharmacy Practice Act. | ||||||
| 17 | "Defined cost sharing" means a deductible payment or | ||||||
| 18 | coinsurance amount imposed on an enrollee for a covered | ||||||
| 19 | prescription drug under the enrollee's health benefit plan. | ||||||
| 20 | "Maximum allowable cost" means the maximum amount that a | ||||||
| 21 | pharmacy benefit manager will reimburse a pharmacy for the | ||||||
| 22 | cost of a drug. | ||||||
| 23 | "Maximum allowable cost list" means a list of drugs for | ||||||
| 24 | which a maximum allowable cost has been established by a | ||||||
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| 1 | pharmacy benefit manager. | ||||||
| 2 | "Pharmacy benefit manager" means a person, business, or | ||||||
| 3 | entity, including a wholly or partially owned or controlled | ||||||
| 4 | subsidiary of a pharmacy benefit manager, that provides claims | ||||||
| 5 | processing services or other prescription drug or device | ||||||
| 6 | services, or both, for health benefit plans. | ||||||
| 7 | "Price protection rebate" means a negotiated price | ||||||
| 8 | concession that accrues directly or indirectly to a health | ||||||
| 9 | insurer, or other party on behalf of the health insurer, if | ||||||
| 10 | there is an increase in the wholesale acquisition cost of a | ||||||
| 11 | prescription drug above a specified threshold. | ||||||
| 12 | "Rebate" means: | ||||||
| 13 | (1) a negotiated price concession, including, without | ||||||
| 14 | limitation, base price concessions, whether described as a | ||||||
| 15 | rebate or not, reasonable estimates of any price | ||||||
| 16 | protection rebates, or performance-based price concessions | ||||||
| 17 | that may accrue, directly or indirectly, to the health | ||||||
| 18 | insurer during the coverage year from a manufacturer or | ||||||
| 19 | other party in connection with the dispensing or | ||||||
| 20 | administration of a prescription drug; or | ||||||
| 21 | (2) any reasonable estimate of a negotiated price | ||||||
| 22 | concession, fee, or other administrative cost that is | ||||||
| 23 | passed through, or is reasonably anticipated to be passed | ||||||
| 24 | through, to the health insurer and serves to reduce the | ||||||
| 25 | health insurer's liabilities for a prescription drug. | ||||||
| 26 | "Retail price" means the price an individual without | ||||||
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| 1 | prescription drug coverage would pay at a retail pharmacy, not | ||||||
| 2 | including a pharmacist dispensing fee. | ||||||
| 3 | "Third-party payer" means any entity that pays for | ||||||
| 4 | prescription drugs on behalf of a patient other than a health | ||||||
| 5 | care provider or sponsor of a plan subject to regulation under | ||||||
| 6 | Medicare Part D, 42 U.S.C. 1395w-101 et seq. | ||||||
| 7 | (b) A contract between a health insurer and a pharmacy | ||||||
| 8 | benefit manager must require that the pharmacy benefit | ||||||
| 9 | manager: | ||||||
| 10 | (1) Update maximum allowable cost pricing information | ||||||
| 11 | at least every 7 calendar days. | ||||||
| 12 | (2) Maintain a process that will, in a timely manner, | ||||||
| 13 | eliminate drugs from maximum allowable cost lists or | ||||||
| 14 | modify drug prices to remain consistent with changes in | ||||||
| 15 | pricing data used in formulating maximum allowable cost | ||||||
| 16 | prices and product availability. | ||||||
| 17 | (3) Provide access to its maximum allowable cost list | ||||||
| 18 | to each pharmacy or pharmacy services administrative | ||||||
| 19 | organization subject to the maximum allowable cost list. | ||||||
| 20 | Access may include a real-time pharmacy website portal to | ||||||
| 21 | be able to view the maximum allowable cost list. As used in | ||||||
| 22 | this Section, "pharmacy services administrative | ||||||
| 23 | organization" means an entity operating within the State | ||||||
| 24 | that contracts with independent pharmacies to conduct | ||||||
| 25 | business on their behalf with third-party payers. A | ||||||
| 26 | pharmacy services administrative organization may provide | ||||||
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| 1 | administrative services to pharmacies and negotiate and | ||||||
| 2 | enter into contracts with third-party payers or pharmacy | ||||||
| 3 | benefit managers on behalf of pharmacies. | ||||||
| 4 | (4) Provide a process by which a contracted pharmacy | ||||||
| 5 | can appeal the provider's reimbursement for a drug subject | ||||||
| 6 | to maximum allowable cost pricing. The appeals process | ||||||
| 7 | must, at a minimum, include the following: | ||||||
| 8 | (A) A requirement that a contracted pharmacy has | ||||||
| 9 | 14 calendar days after the applicable fill date to | ||||||
| 10 | appeal a maximum allowable cost if the reimbursement | ||||||
| 11 | for the drug is less than the net amount that the | ||||||
| 12 | network provider paid to the supplier of the drug. | ||||||
| 13 | (B) A requirement that a pharmacy benefit manager | ||||||
| 14 | must respond to a challenge within 14 calendar days of | ||||||
| 15 | the contracted pharmacy making the claim for which the | ||||||
| 16 | appeal has been submitted. | ||||||
| 17 | (C) A telephone number and e-mail address or | ||||||
| 18 | website to network providers, at which the provider | ||||||
| 19 | can contact the pharmacy benefit manager to process | ||||||
| 20 | and submit an appeal. | ||||||
| 21 | (D) A requirement that, if an appeal is denied, | ||||||
| 22 | the pharmacy benefit manager must provide the reason | ||||||
| 23 | for the denial and the name and the national drug code | ||||||
| 24 | number from national or regional wholesalers. | ||||||
| 25 | (E) A requirement that, if an appeal is sustained, | ||||||
| 26 | the pharmacy benefit manager must make an adjustment | ||||||
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| 1 | in the drug price effective the date the challenge is | ||||||
| 2 | resolved and make the adjustment applicable to all | ||||||
| 3 | similarly situated network pharmacy providers, as | ||||||
| 4 | determined by the managed care organization or | ||||||
| 5 | pharmacy benefit manager. | ||||||
| 6 | (5) Allow a plan sponsor contracting with a pharmacy | ||||||
| 7 | benefit manager an annual right to audit compliance with | ||||||
| 8 | the terms of the contract by the pharmacy benefit manager, | ||||||
| 9 | including, but not limited to, full disclosure of any and | ||||||
| 10 | all rebate amounts secured, whether product specific or | ||||||
| 11 | generalized rebates, that were provided to the pharmacy | ||||||
| 12 | benefit manager by a pharmaceutical manufacturer. | ||||||
| 13 | (6) Allow a plan sponsor contracting with a pharmacy | ||||||
| 14 | benefit manager to request that the pharmacy benefit | ||||||
| 15 | manager disclose the actual amounts paid by the pharmacy | ||||||
| 16 | benefit manager to the pharmacy. | ||||||
| 17 | (7) Provide notice to the party contracting with the | ||||||
| 18 | pharmacy benefit manager of any consideration that the | ||||||
| 19 | pharmacy benefit manager receives from the manufacturer | ||||||
| 20 | for dispense as written prescriptions once a generic or | ||||||
| 21 | biologically similar product becomes available. | ||||||
| 22 | (c) In order to place a particular prescription drug on a | ||||||
| 23 | maximum allowable cost list, the pharmacy benefit manager | ||||||
| 24 | must, at a minimum, ensure that: | ||||||
| 25 | (1) if the drug is a generically equivalent drug, it | ||||||
| 26 | is listed as therapeutically equivalent and | ||||||
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| |||||||
| 1 | pharmaceutically equivalent "A" or "B" rated in the United | ||||||
| 2 | States Food and Drug Administration's most recent version | ||||||
| 3 | of the "Orange Book" or have an NR or NA rating by | ||||||
| 4 | Medi-Span, Gold Standard, or a similar rating by a | ||||||
| 5 | nationally recognized reference; | ||||||
| 6 | (2) the drug is available for purchase by each | ||||||
| 7 | pharmacy in the State from national or regional | ||||||
| 8 | wholesalers operating in Illinois; and | ||||||
| 9 | (3) the drug is not obsolete. | ||||||
| 10 | (d) A pharmacy benefit manager is prohibited from limiting | ||||||
| 11 | a pharmacist's ability to disclose whether the cost-sharing | ||||||
| 12 | obligation exceeds the retail price for a covered prescription | ||||||
| 13 | drug, and the availability of a more affordable alternative | ||||||
| 14 | drug, if one is available in accordance with Section 42 of the | ||||||
| 15 | Pharmacy Practice Act. | ||||||
| 16 | (e) A health insurer or pharmacy benefit manager shall not | ||||||
| 17 | require an insured to make a payment for a prescription drug at | ||||||
| 18 | the point of sale in an amount that exceeds the lesser of: | ||||||
| 19 | (1) the applicable cost-sharing amount; or | ||||||
| 20 | (2) the retail price of the drug in the absence of | ||||||
| 21 | prescription drug coverage. | ||||||
| 22 | (f) Unless required by law, a contract between a pharmacy | ||||||
| 23 | benefit manager or third-party payer and a 340B entity or 340B | ||||||
| 24 | pharmacy shall not contain any provision that: | ||||||
| 25 | (1) distinguishes between drugs purchased through the | ||||||
| 26 | 340B drug discount program and other drugs when | ||||||
| |||||||
| |||||||
| 1 | determining reimbursement or reimbursement methodologies, | ||||||
| 2 | or contains otherwise less favorable payment terms or | ||||||
| 3 | reimbursement methodologies for 340B entities or 340B | ||||||
| 4 | pharmacies when compared to similarly situated non-340B | ||||||
| 5 | entities; | ||||||
| 6 | (2) imposes any fee, chargeback, or rate adjustment | ||||||
| 7 | that is not similarly imposed on similarly situated | ||||||
| 8 | pharmacies that are not 340B entities or 340B pharmacies; | ||||||
| 9 | (3) imposes any fee, chargeback, or rate adjustment | ||||||
| 10 | that exceeds the fee, chargeback, or rate adjustment that | ||||||
| 11 | is not similarly imposed on similarly situated pharmacies | ||||||
| 12 | that are not 340B entities or 340B pharmacies; | ||||||
| 13 | (4) prevents or interferes with an individual's choice | ||||||
| 14 | to receive a covered prescription drug from a 340B entity | ||||||
| 15 | or 340B pharmacy through any legally permissible means, | ||||||
| 16 | except that nothing in this paragraph shall prohibit the | ||||||
| 17 | establishment of differing copayments or other | ||||||
| 18 | cost-sharing amounts within the benefit plan for covered | ||||||
| 19 | persons who acquire covered prescription drugs from a | ||||||
| 20 | nonpreferred or nonparticipating provider; | ||||||
| 21 | (5) excludes a 340B entity or 340B pharmacy from a | ||||||
| 22 | pharmacy network on any basis that includes consideration | ||||||
| 23 | of whether the 340B entity or 340B pharmacy participates | ||||||
| 24 | in the 340B drug discount program; | ||||||
| 25 | (6) prevents a 340B entity or 340B pharmacy from using | ||||||
| 26 | a drug purchased under the 340B drug discount program; or | ||||||
| |||||||
| |||||||
| 1 | (7) any other provision that discriminates against a | ||||||
| 2 | 340B entity or 340B pharmacy by treating the 340B entity | ||||||
| 3 | or 340B pharmacy differently than non-340B entities or | ||||||
| 4 | non-340B pharmacies for any reason relating to the | ||||||
| 5 | entity's participation in the 340B drug discount program. | ||||||
| 6 | (g-5) A covered individual's defined cost sharing for | ||||||
| 7 | each prescription drug shall be calculated at the point of | ||||||
| 8 | sale based on a price that is reduced by an amount equal to at | ||||||
| 9 | least 80% of all rebates received or to be received in | ||||||
| 10 | connection with the dispensing or administration of the | ||||||
| 11 | prescription drug. | ||||||
| 12 | In complying with this Section, a health insurer or its | ||||||
| 13 | agents shall not publish or otherwise reveal information | ||||||
| 14 | regarding the actual amount of rebates a health insurer | ||||||
| 15 | receives on a product or therapeutic class of products, | ||||||
| 16 | manufacturer-specific basis, or pharmacy-specific basis. The | ||||||
| 17 | information described in this subsection is: (i) considered | ||||||
| 18 | protected as a trade secret; (ii) considered proprietary and | ||||||
| 19 | confidential; (iii) not subject to disclosure under the | ||||||
| 20 | federal Freedom of Information Act or the Freedom of | ||||||
| 21 | Information Act; and (iv) not to be disclosed directly, | ||||||
| 22 | indirectly, or in a manner that would either allow for the | ||||||
| 23 | identification of an individual product, therapeutic class of | ||||||
| 24 | products, or manufacturer or have the potential to compromise | ||||||
| 25 | the financial, competitive, or proprietary nature of the | ||||||
| 26 | information. A health insurer shall impose the confidentiality | ||||||
| |||||||
| |||||||
| 1 | protections of this subsection on any vendor or other third | ||||||
| 2 | party that performs health care or administrative services on | ||||||
| 3 | behalf of the health insurer that may receive or have access to | ||||||
| 4 | rebate information. | ||||||
| 5 | Nothing in this subsection precludes a pharmacy benefit | ||||||
| 6 | manager or insurer from reducing an insured's cost sharing by | ||||||
| 7 | an amount greater than that required under this subsection. | ||||||
| 8 | As used in this subsection, "pharmacy benefit manager" and | ||||||
| 9 | "third-party payer" do not include pharmacy benefit managers | ||||||
| 10 | and third-party payers acting on behalf of a Medicaid program. | ||||||
| 11 | (g) A violation of this Section by a pharmacy benefit | ||||||
| 12 | manager constitutes an unfair or deceptive act or practice in | ||||||
| 13 | the business of insurance under Section 424. | ||||||
| 14 | (h) A provision that violates subsection (f) in a contract | ||||||
| 15 | between a pharmacy benefit manager or a third-party payer and | ||||||
| 16 | a 340B entity that is entered into, amended, or renewed after | ||||||
| 17 | July 1, 2022 shall be void and unenforceable. | ||||||
| 18 | (i)(1) A pharmacy benefit manager may not retaliate | ||||||
| 19 | against a pharmacist or pharmacy for disclosing information in | ||||||
| 20 | a court, in an administrative hearing, before a legislative | ||||||
| 21 | commission or committee, or in any other proceeding, if the | ||||||
| 22 | pharmacist or pharmacy has reasonable cause to believe that | ||||||
| 23 | the disclosed information is evidence of a violation of a | ||||||
| 24 | State or federal law, rule, or regulation. | ||||||
| 25 | (2) A pharmacy benefit manager may not retaliate against a | ||||||
| 26 | pharmacist or pharmacy for disclosing information to a | ||||||
| |||||||
| |||||||
| 1 | government or law enforcement agency, if the pharmacist or | ||||||
| 2 | pharmacy has reasonable cause to believe that the disclosed | ||||||
| 3 | information is evidence of a violation of a State or federal | ||||||
| 4 | law, rule, or regulation. | ||||||
| 5 | (3) A pharmacist or pharmacy shall make commercially | ||||||
| 6 | reasonable efforts to limit the disclosure of confidential and | ||||||
| 7 | proprietary information. | ||||||
| 8 | (4) Retaliatory actions against a pharmacy or pharmacist | ||||||
| 9 | include cancellation of, restriction of, or refusal to renew | ||||||
| 10 | or offer a contract to a pharmacy solely because the pharmacy | ||||||
| 11 | or pharmacist has: | ||||||
| 12 | (A) made disclosures of information that the | ||||||
| 13 | pharmacist or pharmacy has reasonable cause to believe is | ||||||
| 14 | evidence of a violation of a State or federal law, rule, or | ||||||
| 15 | regulation; | ||||||
| 16 | (B) filed complaints with the plan or pharmacy benefit | ||||||
| 17 | manager; or | ||||||
| 18 | (C) filed complaints against the plan or pharmacy | ||||||
| 19 | benefit manager with the Department. | ||||||
| 20 | (j) This Section applies to contracts entered into or | ||||||
| 21 | renewed on or after July 1, 2022, except that subsection (g-5) | ||||||
| 22 | applies to contracts entered into or renewed on or after | ||||||
| 23 | January 1, 2026. | ||||||
| 24 | (k) This Section applies to any group or individual policy | ||||||
| 25 | of accident and health insurance or managed care plan that | ||||||
| 26 | provides coverage for prescription drugs and that is amended, | ||||||
| |||||||
| |||||||
| 1 | delivered, issued, or renewed on or after July 1, 2020. | ||||||
| 2 | (Source: P.A. 102-778, eff. 7-1-22; 103-154, eff. 6-30-23; | ||||||
| 3 | 103-453, eff. 8-4-23.) | ||||||
| 4 | Section 15. The Pharmacy Practice Act is amended by | ||||||
| 5 | changing Section 19.5 as follows: | ||||||
| 6 | (225 ILCS 85/19.5) | ||||||
| 7 | (Section scheduled to be repealed on January 1, 2028) | ||||||
| 8 | Sec. 19.5. Biological products. | ||||||
| 9 | (a) For the purposes of this Section: | ||||||
| 10 | "Biological product" has the meaning given to that term in | ||||||
| 11 | 42 U.S.C. 262. | ||||||
| 12 | "Interchangeable biological product" means a biological | ||||||
| 13 | product that the United States Food and Drug Administration: | ||||||
| 14 | (1) has (A) licensed and (B) determined it to meet the | ||||||
| 15 | standards for interchangeability pursuant to 42 U.S.C. | ||||||
| 16 | 262(k)(4); or | ||||||
| 17 | (2) has determined is therapeutically equivalent as | ||||||
| 18 | set forth in the latest edition of or supplement to the | ||||||
| 19 | United States Food and Drug Administration's Approved Drug | ||||||
| 20 | Products with Therapeutic Equivalence Evaluations (Orange | ||||||
| 21 | Book). | ||||||
| 22 | (b) A pharmacist may substitute a an interchangeable | ||||||
| 23 | biological product for a prescribed biological product only if | ||||||
| 24 | all of the following conditions in this subsection (b) are | ||||||
| |||||||
| |||||||
| 1 | met: | ||||||
| 2 | (1) the product being considered for substitution is | ||||||
| 3 | either the reference product or a product approved by the | ||||||
| 4 | United States Food and Drug Administration as a biosimilar | ||||||
| 5 | of the prescribed biological product; the substituted | ||||||
| 6 | product has been determined by the United States Food and | ||||||
| 7 | Drug Administration to be interchangeable, as defined in | ||||||
| 8 | subsection (a) of this Section, with the prescribed | ||||||
| 9 | biological product; | ||||||
| 10 | (2) the prescribing physician does not designate | ||||||
| 11 | orally, in writing, or electronically that substitution is | ||||||
| 12 | prohibited in a manner consistent with Section 25 of this | ||||||
| 13 | Act; and | ||||||
| 14 | (3) the pharmacy informs the patient of the | ||||||
| 15 | substitution. | ||||||
| 16 | (c) Within 5 business days following the dispensing of a | ||||||
| 17 | biological product, the dispensing pharmacist or the | ||||||
| 18 | pharmacist's designee shall make an entry of the specific | ||||||
| 19 | product provided to the patient, including the name of the | ||||||
| 20 | product and the manufacturer. The communication shall be | ||||||
| 21 | conveyed by making an entry that can be electronically | ||||||
| 22 | accessed by the prescriber through: | ||||||
| 23 | (1) an interoperable electronic medical records | ||||||
| 24 | system; | ||||||
| 25 | (2) an electronic prescribing technology; | ||||||
| 26 | (3) a pharmacy benefit management system; or | ||||||
| |||||||
| |||||||
| 1 | (4) a pharmacy record. | ||||||
| 2 | Entry into an electronic records system as described in | ||||||
| 3 | this subsection (c) is presumed to provide notice in | ||||||
| 4 | accordance with this subsection (c). Otherwise, the pharmacist | ||||||
| 5 | shall communicate the biological product dispensed to the | ||||||
| 6 | prescriber using facsimile, telephone, electronic | ||||||
| 7 | transmission, or other prevailing means, except that | ||||||
| 8 | communication shall not be required if where: (A) there is no | ||||||
| 9 | United States Food and Drug Administration-approved | ||||||
| 10 | interchangeable biological product for the product prescribed; | ||||||
| 11 | or (B) a refill prescription is not changed from the product | ||||||
| 12 | dispensed on the prior filling of the prescription. | ||||||
| 13 | (d) The pharmacy shall retain a record of the biological | ||||||
| 14 | product dispensed for a period of 5 years. | ||||||
| 15 | (e) (Blank). The Department shall maintain a link on its | ||||||
| 16 | Internet website to the current list of all biological | ||||||
| 17 | products determined by the United States Food and Drug | ||||||
| 18 | Administration to be interchangeable with a specific | ||||||
| 19 | biological product. | ||||||
| 20 | (f) The Department may adopt rules for compliance with | ||||||
| 21 | this Section. | ||||||
| 22 | (Source: P.A. 99-200, eff. 1-1-16.) | ||||||
