SB3508 - 104th General Assembly
| |||||||
| |||||||
| 1 | AMENDMENT TO SENATE BILL 3508 | ||||||
| 2 | AMENDMENT NO. ______. Amend Senate Bill 3508 on page 1, | ||||||
| 3 | immediately above line 4, by inserting the following: | ||||||
| 4 | "Section 5. The Regulatory Sunset Act is amended by | ||||||
| 5 | changing Section 4.37 and by adding Section 4.47 as follows: | ||||||
| 6 | (5 ILCS 80/4.37) | ||||||
| 7 | Sec. 4.37. Acts and Articles repealed on January 1, 2027. | ||||||
| 8 | The following are repealed on January 1, 2027: | ||||||
| 9 | The Clinical Psychologist Licensing Act. | ||||||
| 10 | The Illinois Optometric Practice Act of 1987. | ||||||
| 11 | Articles II, III, IV, V, VI, VIIA, VIIC, XVII, XXXI, and | ||||||
| 12 | XXXI 1/4 of the Illinois Insurance Code. | ||||||
| 13 | The Boiler and Pressure Vessel Repairer Regulation Act. | ||||||
| 14 | The Marriage and Family Therapy Licensing Act. | ||||||
| 15 | The Boxing and Full-contact Martial Arts Act. | ||||||
| 16 | The Cemetery Oversight Act. | ||||||
| |||||||
| |||||||
| 1 | The Community Association Manager Licensing and | ||||||
| 2 | Disciplinary Act. | ||||||
| 3 | The Detection of Deception Examiners Act. | ||||||
| 4 | The Home Inspector License Act. | ||||||
| 5 | The Massage Licensing Act. | ||||||
| 6 | The Medical Practice Act of 1987. | ||||||
| 7 | The Petroleum Equipment Contractors Licensing Act. | ||||||
| 8 | The Radiation Protection Act of 1990. | ||||||
| 9 | The Real Estate Appraiser Licensing Act of 2002. | ||||||
| 10 | The Registered Interior Designers Act. | ||||||
| 11 | The Landscape Architecture Registration Act. | ||||||
| 12 | The Water Well and Pump Installation Contractor's License | ||||||
| 13 | Act. | ||||||
| 14 | The Licensed Certified Professional Midwife Practice Act. | ||||||
| 15 | (Source: P.A. 102-20, eff. 6-25-21; 102-284, eff. 8-6-21; | ||||||
| 16 | 102-437, eff. 8-20-21; 102-656, eff. 8-27-21; 102-683, eff. | ||||||
| 17 | 10-1-22; 102-813, eff. 5-13-22; 103-371, eff. 1-1-24; 103-823, | ||||||
| 18 | eff. 8-9-24.) | ||||||
| 19 | (5 ILCS 80/4.47 new) | ||||||
| 20 | Sec. 4.47. Articles repealed on January 1, 2037. The | ||||||
| 21 | following Articles are repealed on January 1, 2037: | ||||||
| 22 | Articles II, III, IV, V, VI, VIIA, VIIC, XVII, XXXI, and | ||||||
| 23 | XXXI 1/4 of the Illinois Insurance Code. | ||||||
| 24 | on page 1, line 4, by replacing "5" with "10"; and | ||||||
| |||||||
| |||||||
| 1 | on page 3, line 7, by replacing "10" with "15"; and | ||||||
| 2 | on page 3, by replacing line 8 with "changing Sections 155.49, | ||||||
| 3 | 356z.73, 404, 500-35, and 513b1.1 as"; and | ||||||
| 4 | by deleting line 10 on page 3 through line 20 on page 4; and | ||||||
| 5 | on page 5, by replacing lines 20 through 23 with the following: | ||||||
| 6 | "Each company is required to submit a searchable report, | ||||||
| 7 | in Portable Document Format (PDF), to the Department on or | ||||||
| 8 | before April 1, 2024 and on or before April 1 every year | ||||||
| 9 | thereafter. For reports due on or after April 1, 2027, the | ||||||
| 10 | company shall submit the report in the format designated by | ||||||
| 11 | the Department."; and | ||||||
| 12 | on page 15, immediately below line 7, by inserting the | ||||||
| 13 | following: | ||||||
| 14 | "(215 ILCS 5/513b1.1) | ||||||
| 15 | Sec. 513b1.1. Pharmacy benefit manager reporting | ||||||
| 16 | requirements. | ||||||
| 17 | (a) A pharmacy benefit manager that provides services for | ||||||
| 18 | a health benefit plan must submit an annual report no later | ||||||
| 19 | than September 1, to the Department, each health benefit plan | ||||||
| 20 | sponsor, and each insurer that includes the following: | ||||||
| |||||||
| |||||||
| 1 | (1) data on the health benefit plan including: | ||||||
| 2 | (A) a list of drugs including corresponding | ||||||
| 3 | information on therapeutic class, brand name, generic | ||||||
| 4 | name, or specialty drug name; | ||||||
| 5 | (B) the total number of covered individuals and | ||||||
| 6 | number of Illinois residents who are covered | ||||||
| 7 | individuals; | ||||||
| 8 | (C) number of drug-related claims; | ||||||
| 9 | (D) dosage units; | ||||||
| 10 | (E) dispensing channel used; | ||||||
| 11 | (F) average wholesale acquisition cost per drug; | ||||||
| 12 | and | ||||||
| 13 | (G) total out-of-pocket spending by deidentified | ||||||
| 14 | covered individual per drug, per transaction; | ||||||
| 15 | (2) amount received by the health benefit plan in | ||||||
| 16 | rebates, fees, or discounts related to drug utilization or | ||||||
| 17 | spending; | ||||||
| 18 | (3) total gross spending on drugs by the health | ||||||
| 19 | benefit plan; | ||||||
| 20 | (4) total net spending, gross spending less | ||||||
| 21 | administrative portion of the medical loss ratio, on drugs | ||||||
| 22 | by the health benefit plan; | ||||||
| 23 | (5) the amount paid by the health benefit plan to the | ||||||
| 24 | pharmacy benefit manager for reimbursement cost of a drug | ||||||
| 25 | and service per transaction; | ||||||
| 26 | (6) the amount a pharmacy benefit manager paid for | ||||||
| |||||||
| |||||||
| 1 | pharmacists' services and drugs rendered related to the | ||||||
| 2 | health benefit plan per transaction, including, but not | ||||||
| 3 | limited to, any dispensing fee; | ||||||
| 4 | (7) the specific rebate amount received by the | ||||||
| 5 | pharmacy benefit manager per transaction, the amount of | ||||||
| 6 | the rebates passed through to the health benefit plan per | ||||||
| 7 | transaction, and the amount of the rebates passed on to | ||||||
| 8 | covered individuals at the point of sale that reduced the | ||||||
| 9 | covered individuals' applicable deductible, copayment, | ||||||
| 10 | coinsurance, or other cost-sharing amount per transaction; | ||||||
| 11 | (8) any information collected from drug manufacturers | ||||||
| 12 | pertaining to copayment assistance to the extent such | ||||||
| 13 | information is collected; | ||||||
| 14 | (9) any compensation paid to brokers, consultants, | ||||||
| 15 | advisors, or any other individual or firm for referrals, | ||||||
| 16 | consideration, or retention by the health benefit plan; | ||||||
| 17 | (10) explanation of benefit design parameters | ||||||
| 18 | encouraging or requiring covered individuals to use | ||||||
| 19 | affiliated pharmacies, percentage of drugs charged by | ||||||
| 20 | these pharmacies, and a list of drugs dispensed by | ||||||
| 21 | affiliated pharmacies with their associated costs; and | ||||||
| 22 | (11) a complete copy of each unredacted contract the | ||||||
| 23 | pharmacy benefit manager has with the health benefit plan | ||||||
| 24 | sponsor or insurer. | ||||||
| 25 | (b) Annual reports pursuant to subsection (a): | ||||||
| 26 | (1) must be written in plain language to ensure ease | ||||||
| |||||||
| |||||||
| 1 | of reading and accessibility; | ||||||
| 2 | (2) must only contain summary health information to | ||||||
| 3 | ensure plan, coverage, or covered individual information | ||||||
| 4 | remains private and confidential; | ||||||
| 5 | (3) upon request by a covered individual, must be | ||||||
| 6 | available in summary format and provide aggregated | ||||||
| 7 | information to help covered individuals understand their | ||||||
| 8 | health benefit plan's drug coverage; and | ||||||
| 9 | (4) must be filed with the Department no later than | ||||||
| 10 | September 1 of each year in the format designated by the | ||||||
| 11 | Department via the Systems for Electronic Rates & Forms | ||||||
| 12 | Filing (SERFF). The filing shall include the summary | ||||||
| 13 | version of the report described in paragraph (3) of this | ||||||
| 14 | subsection, which the Department shall make available to | ||||||
| 15 | members of the public be marked for public access. | ||||||
| 16 | The Department may share all reports with an established | ||||||
| 17 | institution of higher education in this State for the creation | ||||||
| 18 | of a pharmacist dispensing cost report to be produced | ||||||
| 19 | annually. This annual pharmacist dispensing cost report shall | ||||||
| 20 | provide a survey of the average cost of dispensing a | ||||||
| 21 | prescription for pharmacists in Illinois. The institution of | ||||||
| 22 | higher education shall have the ability to request additional | ||||||
| 23 | information from pharmacists for its analysis. The institution | ||||||
| 24 | of higher education shall issue the report to the General | ||||||
| 25 | Assembly no later than December 31, 2026 and annually | ||||||
| 26 | thereafter. | ||||||
| |||||||
| |||||||
| 1 | (c) A pharmacy benefit manager may petition the Department | ||||||
| 2 | for a filing submission extension. The Director may grant or | ||||||
| 3 | deny the extension within 5 business days. | ||||||
| 4 | (d) Failure by a pharmacy benefit manager to submit all | ||||||
| 5 | required elements in an annual report to the Department may | ||||||
| 6 | result in a fine levied by the Director not to exceed $10,000 | ||||||
| 7 | per day, per offense. Funds derived from fines levied shall be | ||||||
| 8 | deposited into the Insurance Producer Administration Fund. | ||||||
| 9 | Fine information shall be posted on the Department's website. | ||||||
| 10 | (e) A pharmacy benefit manager found in violation of | ||||||
| 11 | subsection (a) or paragraph (4) of subsection (b) may request | ||||||
| 12 | a hearing from the Director within 10 days of receipt of the | ||||||
| 13 | Director's order, or, if the violation is found in a market | ||||||
| 14 | conduct examination, as provided in Section 132 of this Code. | ||||||
| 15 | (f) Except for the summary version, the annual reports | ||||||
| 16 | submitted by pharmacy benefit managers shall be considered | ||||||
| 17 | confidential and privileged for all purposes, including for | ||||||
| 18 | purposes of the Freedom of Information Act, shall not be | ||||||
| 19 | subject to subpoena from any private party, and shall not be | ||||||
| 20 | admissible as evidence in a civil action. | ||||||
| 21 | (g) A copy of an adverse decision against a pharmacy | ||||||
| 22 | benefit manager for failing to submit an annual report to the | ||||||
| 23 | Department must be posted to the Department's website. | ||||||
| 24 | (h) Nothing in this Section shall be construed as | ||||||
| 25 | permitting a pharmacy benefit manager to avoid or otherwise | ||||||
| 26 | fail to comply with the reporting requirements set forth in | ||||||
| |||||||
| |||||||
| 1 | Section 5-36 of the Illinois Public Aid Code. | ||||||
| 2 | (Source: P.A. 104-27, eff. 1-1-26; 104-439, eff. 12-2-25.)"; | ||||||
| 3 | and | ||||||
| 4 | on page 15, line 9, by replacing "15" with "20"; and | ||||||
| 5 | on page 15, line 11, by replacing "20" with "25". | ||||||
