Full Text of HB4548 103rd General Assembly
HB4548ham001 103RD GENERAL ASSEMBLY | Rep. Thaddeus Jones Filed: 4/1/2024 | | 10300HB4548ham001 | | LRB103 35901 RPS 70762 a |
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| 1 | | AMENDMENT TO HOUSE BILL 4548
| 2 | | AMENDMENT NO. ______. Amend House Bill 4548 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Freedom of Information Act is amended by | 5 | | changing Section 7 as follows: | 6 | | (5 ILCS 140/7) | 7 | | Sec. 7. Exemptions. | 8 | | (1) When a request is made to inspect or copy a public | 9 | | record that contains information that is exempt from | 10 | | disclosure under this Section, but also contains information | 11 | | that is not exempt from disclosure, the public body may elect | 12 | | to redact the information that is exempt. The public body | 13 | | shall make the remaining information available for inspection | 14 | | and copying. Subject to this requirement, the following shall | 15 | | be exempt from inspection and copying: | 16 | | (a) Information specifically prohibited from |
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| 1 | | disclosure by federal or State law or rules and | 2 | | regulations implementing federal or State law. | 3 | | (b) Private information, unless disclosure is required | 4 | | by another provision of this Act, a State or federal law, | 5 | | or a court order. | 6 | | (b-5) Files, documents, and other data or databases | 7 | | maintained by one or more law enforcement agencies and | 8 | | specifically designed to provide information to one or | 9 | | more law enforcement agencies regarding the physical or | 10 | | mental status of one or more individual subjects. | 11 | | (c) Personal information contained within public | 12 | | records, the disclosure of which would constitute a | 13 | | clearly unwarranted invasion of personal privacy, unless | 14 | | the disclosure is consented to in writing by the | 15 | | individual subjects of the information. "Unwarranted | 16 | | invasion of personal privacy" means the disclosure of | 17 | | information that is highly personal or objectionable to a | 18 | | reasonable person and in which the subject's right to | 19 | | privacy outweighs any legitimate public interest in | 20 | | obtaining the information. The disclosure of information | 21 | | that bears on the public duties of public employees and | 22 | | officials shall not be considered an invasion of personal | 23 | | privacy. | 24 | | (d) Records in the possession of any public body | 25 | | created in the course of administrative enforcement | 26 | | proceedings, and any law enforcement or correctional |
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| 1 | | agency for law enforcement purposes, but only to the | 2 | | extent that disclosure would: | 3 | | (i) interfere with pending or actually and | 4 | | reasonably contemplated law enforcement proceedings | 5 | | conducted by any law enforcement or correctional | 6 | | agency that is the recipient of the request; | 7 | | (ii) interfere with active administrative | 8 | | enforcement proceedings conducted by the public body | 9 | | that is the recipient of the request; | 10 | | (iii) create a substantial likelihood that a | 11 | | person will be deprived of a fair trial or an impartial | 12 | | hearing; | 13 | | (iv) unavoidably disclose the identity of a | 14 | | confidential source, confidential information | 15 | | furnished only by the confidential source, or persons | 16 | | who file complaints with or provide information to | 17 | | administrative, investigative, law enforcement, or | 18 | | penal agencies; except that the identities of | 19 | | witnesses to traffic crashes, traffic crash reports, | 20 | | and rescue reports shall be provided by agencies of | 21 | | local government, except when disclosure would | 22 | | interfere with an active criminal investigation | 23 | | conducted by the agency that is the recipient of the | 24 | | request; | 25 | | (v) disclose unique or specialized investigative | 26 | | techniques other than those generally used and known |
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| 1 | | or disclose internal documents of correctional | 2 | | agencies related to detection, observation, or | 3 | | investigation of incidents of crime or misconduct, and | 4 | | disclosure would result in demonstrable harm to the | 5 | | agency or public body that is the recipient of the | 6 | | request; | 7 | | (vi) endanger the life or physical safety of law | 8 | | enforcement personnel or any other person; or | 9 | | (vii) obstruct an ongoing criminal investigation | 10 | | by the agency that is the recipient of the request. | 11 | | (d-5) A law enforcement record created for law | 12 | | enforcement purposes and contained in a shared electronic | 13 | | record management system if the law enforcement agency | 14 | | that is the recipient of the request did not create the | 15 | | record, did not participate in or have a role in any of the | 16 | | events which are the subject of the record, and only has | 17 | | access to the record through the shared electronic record | 18 | | management system. | 19 | | (d-6) Records contained in the Officer Professional | 20 | | Conduct Database under Section 9.2 of the Illinois Police | 21 | | Training Act, except to the extent authorized under that | 22 | | Section. This includes the documents supplied to the | 23 | | Illinois Law Enforcement Training Standards Board from the | 24 | | Illinois State Police and Illinois State Police Merit | 25 | | Board. | 26 | | (d-7) Information gathered or records created from the |
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| 1 | | use of automatic license plate readers in connection with | 2 | | Section 2-130 of the Illinois Vehicle Code. | 3 | | (e) Records that relate to or affect the security of | 4 | | correctional institutions and detention facilities. | 5 | | (e-5) Records requested by persons committed to the | 6 | | Department of Corrections, Department of Human Services | 7 | | Division of Mental Health, or a county jail if those | 8 | | materials are available in the library of the correctional | 9 | | institution or facility or jail where the inmate is | 10 | | confined. | 11 | | (e-6) Records requested by persons committed to the | 12 | | Department of Corrections, Department of Human Services | 13 | | Division of Mental Health, or a county jail if those | 14 | | materials include records from staff members' personnel | 15 | | files, staff rosters, or other staffing assignment | 16 | | information. | 17 | | (e-7) Records requested by persons committed to the | 18 | | Department of Corrections or Department of Human Services | 19 | | Division of Mental Health if those materials are available | 20 | | through an administrative request to the Department of | 21 | | Corrections or Department of Human Services Division of | 22 | | Mental Health. | 23 | | (e-8) Records requested by a person committed to the | 24 | | Department of Corrections, Department of Human Services | 25 | | Division of Mental Health, or a county jail, the | 26 | | disclosure of which would result in the risk of harm to any |
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| 1 | | person or the risk of an escape from a jail or correctional | 2 | | institution or facility. | 3 | | (e-9) Records requested by a person in a county jail | 4 | | or committed to the Department of Corrections or | 5 | | Department of Human Services Division of Mental Health, | 6 | | containing personal information pertaining to the person's | 7 | | victim or the victim's family, including, but not limited | 8 | | to, a victim's home address, home telephone number, work | 9 | | or school address, work telephone number, social security | 10 | | number, or any other identifying information, except as | 11 | | may be relevant to a requester's current or potential case | 12 | | or claim. | 13 | | (e-10) Law enforcement records of other persons | 14 | | requested by a person committed to the Department of | 15 | | Corrections, Department of Human Services Division of | 16 | | Mental Health, or a county jail, including, but not | 17 | | limited to, arrest and booking records, mug shots, and | 18 | | crime scene photographs, except as these records may be | 19 | | relevant to the requester's current or potential case or | 20 | | claim. | 21 | | (f) Preliminary drafts, notes, recommendations, | 22 | | memoranda, and other records in which opinions are | 23 | | expressed, or policies or actions are formulated, except | 24 | | that a specific record or relevant portion of a record | 25 | | shall not be exempt when the record is publicly cited and | 26 | | identified by the head of the public body. The exemption |
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| 1 | | provided in this paragraph (f) extends to all those | 2 | | records of officers and agencies of the General Assembly | 3 | | that pertain to the preparation of legislative documents. | 4 | | (g) Trade secrets and commercial or financial | 5 | | information obtained from a person or business where the | 6 | | trade secrets or commercial or financial information are | 7 | | furnished under a claim that they are proprietary, | 8 | | privileged, or confidential, and that disclosure of the | 9 | | trade secrets or commercial or financial information would | 10 | | cause competitive harm to the person or business, and only | 11 | | insofar as the claim directly applies to the records | 12 | | requested. | 13 | | The information included under this exemption includes | 14 | | all trade secrets and commercial or financial information | 15 | | obtained by a public body, including a public pension | 16 | | fund, from a private equity fund or a privately held | 17 | | company within the investment portfolio of a private | 18 | | equity fund as a result of either investing or evaluating | 19 | | a potential investment of public funds in a private equity | 20 | | fund. The exemption contained in this item does not apply | 21 | | to the aggregate financial performance information of a | 22 | | private equity fund, nor to the identity of the fund's | 23 | | managers or general partners. The exemption contained in | 24 | | this item does not apply to the identity of a privately | 25 | | held company within the investment portfolio of a private | 26 | | equity fund, unless the disclosure of the identity of a |
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| 1 | | privately held company may cause competitive harm. | 2 | | Nothing contained in this paragraph (g) shall be | 3 | | construed to prevent a person or business from consenting | 4 | | to disclosure. | 5 | | (h) Proposals and bids for any contract, grant, or | 6 | | agreement, including information which if it were | 7 | | disclosed would frustrate procurement or give an advantage | 8 | | to any person proposing to enter into a contractor | 9 | | agreement with the body, until an award or final selection | 10 | | is made. Information prepared by or for the body in | 11 | | preparation of a bid solicitation shall be exempt until an | 12 | | award or final selection is made. | 13 | | (i) Valuable formulae, computer geographic systems, | 14 | | designs, drawings, and research data obtained or produced | 15 | | by any public body when disclosure could reasonably be | 16 | | expected to produce private gain or public loss. The | 17 | | exemption for "computer geographic systems" provided in | 18 | | this paragraph (i) does not extend to requests made by | 19 | | news media as defined in Section 2 of this Act when the | 20 | | requested information is not otherwise exempt and the only | 21 | | purpose of the request is to access and disseminate | 22 | | information regarding the health, safety, welfare, or | 23 | | legal rights of the general public. | 24 | | (j) The following information pertaining to | 25 | | educational matters: | 26 | | (i) test questions, scoring keys, and other |
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| 1 | | examination data used to administer an academic | 2 | | examination; | 3 | | (ii) information received by a primary or | 4 | | secondary school, college, or university under its | 5 | | procedures for the evaluation of faculty members by | 6 | | their academic peers; | 7 | | (iii) information concerning a school or | 8 | | university's adjudication of student disciplinary | 9 | | cases, but only to the extent that disclosure would | 10 | | unavoidably reveal the identity of the student; and | 11 | | (iv) course materials or research materials used | 12 | | by faculty members. | 13 | | (k) Architects' plans, engineers' technical | 14 | | submissions, and other construction related technical | 15 | | documents for projects not constructed or developed in | 16 | | whole or in part with public funds and the same for | 17 | | projects constructed or developed with public funds, | 18 | | including, but not limited to, power generating and | 19 | | distribution stations and other transmission and | 20 | | distribution facilities, water treatment facilities, | 21 | | airport facilities, sport stadiums, convention centers, | 22 | | and all government owned, operated, or occupied buildings, | 23 | | but only to the extent that disclosure would compromise | 24 | | security. | 25 | | (l) Minutes of meetings of public bodies closed to the | 26 | | public as provided in the Open Meetings Act until the |
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| 1 | | public body makes the minutes available to the public | 2 | | under Section 2.06 of the Open Meetings Act. | 3 | | (m) Communications between a public body and an | 4 | | attorney or auditor representing the public body that | 5 | | would not be subject to discovery in litigation, and | 6 | | materials prepared or compiled by or for a public body in | 7 | | anticipation of a criminal, civil, or administrative | 8 | | proceeding upon the request of an attorney advising the | 9 | | public body, and materials prepared or compiled with | 10 | | respect to internal audits of public bodies. | 11 | | (n) Records relating to a public body's adjudication | 12 | | of employee grievances or disciplinary cases; however, | 13 | | this exemption shall not extend to the final outcome of | 14 | | cases in which discipline is imposed. | 15 | | (o) Administrative or technical information associated | 16 | | with automated data processing operations, including, but | 17 | | not limited to, software, operating protocols, computer | 18 | | program abstracts, file layouts, source listings, object | 19 | | modules, load modules, user guides, documentation | 20 | | pertaining to all logical and physical design of | 21 | | computerized systems, employee manuals, and any other | 22 | | information that, if disclosed, would jeopardize the | 23 | | security of the system or its data or the security of | 24 | | materials exempt under this Section. | 25 | | (p) Records relating to collective negotiating matters | 26 | | between public bodies and their employees or |
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| 1 | | representatives, except that any final contract or | 2 | | agreement shall be subject to inspection and copying. | 3 | | (q) Test questions, scoring keys, and other | 4 | | examination data used to determine the qualifications of | 5 | | an applicant for a license or employment. | 6 | | (r) The records, documents, and information relating | 7 | | to real estate purchase negotiations until those | 8 | | negotiations have been completed or otherwise terminated. | 9 | | With regard to a parcel involved in a pending or actually | 10 | | and reasonably contemplated eminent domain proceeding | 11 | | under the Eminent Domain Act, records, documents, and | 12 | | information relating to that parcel shall be exempt except | 13 | | as may be allowed under discovery rules adopted by the | 14 | | Illinois Supreme Court. The records, documents, and | 15 | | information relating to a real estate sale shall be exempt | 16 | | until a sale is consummated. | 17 | | (s) Any and all proprietary information and records | 18 | | related to the operation of an intergovernmental risk | 19 | | management association or self-insurance pool or jointly | 20 | | self-administered health and accident cooperative or pool. | 21 | | Insurance or self-insurance (including any | 22 | | intergovernmental risk management association or | 23 | | self-insurance pool) claims, loss or risk management | 24 | | information, records, data, advice, or communications. | 25 | | (t) Information contained in or related to | 26 | | examination, operating, or condition reports prepared by, |
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| 1 | | on behalf of, or for the use of a public body responsible | 2 | | for the regulation or supervision of financial | 3 | | institutions, insurance companies, or pharmacy benefit | 4 | | managers, unless disclosure is otherwise required by State | 5 | | law. | 6 | | (u) Information that would disclose or might lead to | 7 | | the disclosure of secret or confidential information, | 8 | | codes, algorithms, programs, or private keys intended to | 9 | | be used to create electronic signatures under the Uniform | 10 | | Electronic Transactions Act. | 11 | | (v) Vulnerability assessments, security measures, and | 12 | | response policies or plans that are designed to identify, | 13 | | prevent, or respond to potential attacks upon a | 14 | | community's population or systems, facilities, or | 15 | | installations, but only to the extent that disclosure | 16 | | could reasonably be expected to expose the vulnerability | 17 | | or jeopardize the effectiveness of the measures, policies, | 18 | | or plans, or the safety of the personnel who implement | 19 | | them or the public. Information exempt under this item may | 20 | | include such things as details pertaining to the | 21 | | mobilization or deployment of personnel or equipment, to | 22 | | the operation of communication systems or protocols, to | 23 | | cybersecurity vulnerabilities, or to tactical operations. | 24 | | (w) (Blank). | 25 | | (x) Maps and other records regarding the location or | 26 | | security of generation, transmission, distribution, |
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| 1 | | storage, gathering, treatment, or switching facilities | 2 | | owned by a utility, by a power generator, or by the | 3 | | Illinois Power Agency. | 4 | | (y) Information contained in or related to proposals, | 5 | | bids, or negotiations related to electric power | 6 | | procurement under Section 1-75 of the Illinois Power | 7 | | Agency Act and Section 16-111.5 of the Public Utilities | 8 | | Act that is determined to be confidential and proprietary | 9 | | by the Illinois Power Agency or by the Illinois Commerce | 10 | | Commission. | 11 | | (z) Information about students exempted from | 12 | | disclosure under Section 10-20.38 or 34-18.29 of the | 13 | | School Code, and information about undergraduate students | 14 | | enrolled at an institution of higher education exempted | 15 | | from disclosure under Section 25 of the Illinois Credit | 16 | | Card Marketing Act of 2009. | 17 | | (aa) Information the disclosure of which is exempted | 18 | | under the Viatical Settlements Act of 2009. | 19 | | (bb) Records and information provided to a mortality | 20 | | review team and records maintained by a mortality review | 21 | | team appointed under the Department of Juvenile Justice | 22 | | Mortality Review Team Act. | 23 | | (cc) Information regarding interments, entombments, or | 24 | | inurnments of human remains that are submitted to the | 25 | | Cemetery Oversight Database under the Cemetery Care Act or | 26 | | the Cemetery Oversight Act, whichever is applicable. |
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| 1 | | (dd) Correspondence and records (i) that may not be | 2 | | disclosed under Section 11-9 of the Illinois Public Aid | 3 | | Code or (ii) that pertain to appeals under Section 11-8 of | 4 | | the Illinois Public Aid Code. | 5 | | (ee) The names, addresses, or other personal | 6 | | information of persons who are minors and are also | 7 | | participants and registrants in programs of park | 8 | | districts, forest preserve districts, conservation | 9 | | districts, recreation agencies, and special recreation | 10 | | associations. | 11 | | (ff) The names, addresses, or other personal | 12 | | information of participants and registrants in programs of | 13 | | park districts, forest preserve districts, conservation | 14 | | districts, recreation agencies, and special recreation | 15 | | associations where such programs are targeted primarily to | 16 | | minors. | 17 | | (gg) Confidential information described in Section | 18 | | 1-100 of the Illinois Independent Tax Tribunal Act of | 19 | | 2012. | 20 | | (hh) The report submitted to the State Board of | 21 | | Education by the School Security and Standards Task Force | 22 | | under item (8) of subsection (d) of Section 2-3.160 of the | 23 | | School Code and any information contained in that report. | 24 | | (ii) Records requested by persons committed to or | 25 | | detained by the Department of Human Services under the | 26 | | Sexually Violent Persons Commitment Act or committed to |
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| 1 | | the Department of Corrections under the Sexually Dangerous | 2 | | Persons Act if those materials: (i) are available in the | 3 | | library of the facility where the individual is confined; | 4 | | (ii) include records from staff members' personnel files, | 5 | | staff rosters, or other staffing assignment information; | 6 | | or (iii) are available through an administrative request | 7 | | to the Department of Human Services or the Department of | 8 | | Corrections. | 9 | | (jj) Confidential information described in Section | 10 | | 5-535 of the Civil Administrative Code of Illinois. | 11 | | (kk) The public body's credit card numbers, debit card | 12 | | numbers, bank account numbers, Federal Employer | 13 | | Identification Number, security code numbers, passwords, | 14 | | and similar account information, the disclosure of which | 15 | | could result in identity theft or impression or defrauding | 16 | | of a governmental entity or a person. | 17 | | (ll) Records concerning the work of the threat | 18 | | assessment team of a school district, including, but not | 19 | | limited to, any threat assessment procedure under the | 20 | | School Safety Drill Act and any information contained in | 21 | | the procedure. | 22 | | (mm) Information prohibited from being disclosed under | 23 | | subsections (a) and (b) of Section 15 of the Student | 24 | | Confidential Reporting Act. | 25 | | (nn) Proprietary information submitted to the | 26 | | Environmental Protection Agency under the Drug Take-Back |
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| 1 | | Act. | 2 | | (oo) Records described in subsection (f) of Section | 3 | | 3-5-1 of the Unified Code of Corrections. | 4 | | (pp) Any and all information regarding burials, | 5 | | interments, or entombments of human remains as required to | 6 | | be reported to the Department of Natural Resources | 7 | | pursuant either to the Archaeological and Paleontological | 8 | | Resources Protection Act or the Human Remains Protection | 9 | | Act. | 10 | | (qq) (pp) Reports described in subsection (e) of | 11 | | Section 16-15 of the Abortion Care Clinical Training | 12 | | Program Act. | 13 | | (rr) (pp) Information obtained by a certified local | 14 | | health department under the Access to Public Health Data | 15 | | Act. | 16 | | (ss) (pp) For a request directed to a public body that | 17 | | is also a HIPAA-covered entity, all information that is | 18 | | protected health information, including demographic | 19 | | information, that may be contained within or extracted | 20 | | from any record held by the public body in compliance with | 21 | | State and federal medical privacy laws and regulations, | 22 | | including, but not limited to, the Health Insurance | 23 | | Portability and Accountability Act and its regulations, 45 | 24 | | CFR Parts 160 and 164. As used in this paragraph, | 25 | | "HIPAA-covered entity" has the meaning given to the term | 26 | | "covered entity" in 45 CFR 160.103 and "protected health |
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| 1 | | information" has the meaning given to that term in 45 CFR | 2 | | 160.103. | 3 | | (tt) Annual reports submitted by pharmacy benefit | 4 | | managers under Section 513b1.5 of the Illinois Insurance | 5 | | Code, except for the summary versions of the reports under | 6 | | paragraph (3) of subsection (b) of Section 513b1.5 of the | 7 | | Illinois Insurance Code. | 8 | | (1.5) Any information exempt from disclosure under the | 9 | | Judicial Privacy Act shall be redacted from public records | 10 | | prior to disclosure under this Act. | 11 | | (2) A public record that is not in the possession of a | 12 | | public body but is in the possession of a party with whom the | 13 | | agency has contracted to perform a governmental function on | 14 | | behalf of the public body, and that directly relates to the | 15 | | governmental function and is not otherwise exempt under this | 16 | | Act, shall be considered a public record of the public body, | 17 | | for purposes of this Act. | 18 | | (3) This Section does not authorize withholding of | 19 | | information or limit the availability of records to the | 20 | | public, except as stated in this Section or otherwise provided | 21 | | in this Act. | 22 | | (Source: P.A. 102-38, eff. 6-25-21; 102-558, eff. 8-20-21; | 23 | | 102-694, eff. 1-7-22; 102-752, eff. 5-6-22; 102-753, eff. | 24 | | 1-1-23; 102-776, eff. 1-1-23; 102-791, eff. 5-13-22; 102-982, | 25 | | eff. 7-1-23; 102-1055, eff. 6-10-22; 103-154, eff. 6-30-23; | 26 | | 103-423, eff. 1-1-24; 103-446, eff. 8-4-23; 103-462, eff. |
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| 1 | | 8-4-23; 103-540, eff. 1-1-24; 103-554, eff. 1-1-24; revised | 2 | | 9-7-23.) | 3 | | Section 10. The Illinois Insurance Code is amended by | 4 | | changing Section 513b1 and by adding Section 513b1.5 as | 5 | | follows: | 6 | | (215 ILCS 5/513b1) | 7 | | Sec. 513b1. Pharmacy benefit manager contracts. | 8 | | (a) As used in this Section: | 9 | | "340B drug discount program" means the program established | 10 | | under Section 340B of the federal Public Health Service Act, | 11 | | 42 U.S.C. 256b. | 12 | | "340B entity" means a covered entity as defined in 42 | 13 | | U.S.C. 256b(a)(4) authorized to participate in the 340B drug | 14 | | discount program. | 15 | | "340B pharmacy" means any pharmacy used to dispense 340B | 16 | | drugs for a covered entity, whether entity-owned or external. | 17 | | "Biological product" has the meaning ascribed to that term | 18 | | in Section 19.5 of the Pharmacy Practice Act. | 19 | | "Covered individual" means a member, participant, | 20 | | enrollee, contract holder, policyholder, or beneficiary of a | 21 | | health benefit plan who is provided a prescription drug | 22 | | benefit by the health benefit plan. | 23 | | "Health benefit plan" means a policy, contract, | 24 | | certificate, or agreement entered into, offered, or issued by |
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| 1 | | an insurer to provide, deliver, arrange for, pay for, or | 2 | | reimburse any of the costs of physical, mental, or behavioral | 3 | | health care services. "Health benefit plan" does not include | 4 | | Medicaid managed care organizations, as defined in Section | 5 | | 5-30.1 of the Illinois Public Aid Code, or employee welfare | 6 | | benefit plans subject to the federal Employee Retirement | 7 | | Income Security Act of 1974. | 8 | | "Maximum allowable cost" means the maximum amount that a | 9 | | pharmacy benefit manager will reimburse a pharmacy for the | 10 | | cost of a drug. | 11 | | "Maximum allowable cost list" means a list of drugs for | 12 | | which a maximum allowable cost has been established by a | 13 | | pharmacy benefit manager. | 14 | | "Pharmacy benefit manager" means a person, business, or | 15 | | entity, including a wholly or partially owned or controlled | 16 | | subsidiary of a pharmacy benefit manager, that provides claims | 17 | | processing services or other prescription drug or device | 18 | | services, or both, for health benefit plans. | 19 | | "Rebate aggregator" means a person or entity that | 20 | | negotiates rebates, discounts, or other fees attributable to | 21 | | usage by covered individuals with drug manufacturers on behalf | 22 | | of pharmacy benefit managers or their clients and may also be | 23 | | involved in contracts that entitle the rebate aggregator or | 24 | | its client to receive rebates, discounts, or other fees | 25 | | attributable to usage by covered individuals from drug | 26 | | manufacturers based on drug utilization or administration. |
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| 1 | | "Retail price" means the price an individual without | 2 | | prescription drug coverage would pay at a retail pharmacy, not | 3 | | including a pharmacist dispensing fee. | 4 | | "Spread pricing" means the model of prescription drug | 5 | | pricing in which the pharmacy benefit manager charges a health | 6 | | benefit plan a contracted price for prescription drugs and the | 7 | | contracted price for the prescription drugs differs from the | 8 | | amount the pharmacy benefit manager directly or indirectly | 9 | | pays the pharmacist or pharmacy for pharmacist services. | 10 | | "Steer" includes, but is not limited to: | 11 | | (1) requiring a covered individual to use only a | 12 | | pharmacy, including a mail-order pharmacy, in which the | 13 | | pharmacy benefit manager maintains an ownership interest | 14 | | or control; | 15 | | (2) offering or implementing a plan design that | 16 | | encourages a covered individual to use a pharmacy in which | 17 | | the pharmacy benefit manager maintains an ownership | 18 | | interest or control, if such plan design increases costs | 19 | | for the covered individual, including requiring a covered | 20 | | individual to pay full costs for a prescription if the | 21 | | covered individual chooses not to use a pharmacy owned or | 22 | | controlled by the pharmacy benefit manager; | 23 | | (3) reimbursing a pharmacy or pharmacist for a | 24 | | pharmaceutical product or pharmacist service in an amount | 25 | | less than the amount that the pharmacy benefit manager | 26 | | reimburses itself or an affiliate for providing the same |
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| 1 | | product or services, unless the pharmacy or pharmacist | 2 | | contractually agrees to a lower reimbursement amount; or | 3 | | (4) any other actions determined by the Department by | 4 | | rule. | 5 | | "Third-party payer" means any entity that pays for | 6 | | prescription drugs on behalf of a patient other than a health | 7 | | care provider or sponsor of a plan subject to regulation under | 8 | | Medicare Part D, 42 U.S.C. 1395w-101 et seq. | 9 | | (b) A contract between a health insurer and a pharmacy | 10 | | benefit manager must require that the pharmacy benefit | 11 | | manager: | 12 | | (1) Update maximum allowable cost pricing information | 13 | | at least every 7 calendar days. | 14 | | (2) Maintain a process that will, in a timely manner, | 15 | | eliminate drugs from maximum allowable cost lists or | 16 | | modify drug prices to remain consistent with changes in | 17 | | pricing data used in formulating maximum allowable cost | 18 | | prices and product availability. | 19 | | (3) Provide access to its maximum allowable cost list | 20 | | to each pharmacy or pharmacy services administrative | 21 | | organization subject to the maximum allowable cost list. | 22 | | Access may include a real-time pharmacy website portal to | 23 | | be able to view the maximum allowable cost list. As used in | 24 | | this Section, "pharmacy services administrative | 25 | | organization" means an entity operating within the State | 26 | | that contracts with independent pharmacies to conduct |
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| 1 | | business on their behalf with third-party payers. A | 2 | | pharmacy services administrative organization may provide | 3 | | administrative services to pharmacies and negotiate and | 4 | | enter into contracts with third-party payers or pharmacy | 5 | | benefit managers on behalf of pharmacies. | 6 | | (4) Provide a process by which a contracted pharmacy | 7 | | can appeal the provider's reimbursement for a drug subject | 8 | | to maximum allowable cost pricing. The appeals process | 9 | | must, at a minimum, include the following: | 10 | | (A) A requirement that a contracted pharmacy has | 11 | | 14 calendar days after the applicable fill date to | 12 | | appeal a maximum allowable cost if the reimbursement | 13 | | for the drug is less than the net amount that the | 14 | | network provider paid to the supplier of the drug. | 15 | | (B) A requirement that a pharmacy benefit manager | 16 | | must respond to a challenge within 14 calendar days of | 17 | | the contracted pharmacy making the claim for which the | 18 | | appeal has been submitted. | 19 | | (C) A telephone number and e-mail address or | 20 | | website to network providers, at which the provider | 21 | | can contact the pharmacy benefit manager to process | 22 | | and submit an appeal. | 23 | | (D) A requirement that, if an appeal is denied, | 24 | | the pharmacy benefit manager must provide the reason | 25 | | for the denial and the name and the national drug code | 26 | | number from national or regional wholesalers. |
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| 1 | | (E) A requirement that, if an appeal is sustained, | 2 | | the pharmacy benefit manager must make an adjustment | 3 | | in the drug price effective the date the challenge is | 4 | | resolved and make the adjustment applicable to all | 5 | | similarly situated network pharmacy providers, as | 6 | | determined by the managed care organization or | 7 | | pharmacy benefit manager. | 8 | | (5) Allow a plan sponsor whose coverage is | 9 | | administered by the contracting with a pharmacy benefit | 10 | | manager an annual right to audit compliance with the terms | 11 | | of the contract by the pharmacy benefit manager, | 12 | | including, but not limited to, full disclosure of any and | 13 | | all rebate amounts secured, whether product specific or | 14 | | generalized rebates, that were provided to the pharmacy | 15 | | benefit manager by a pharmaceutical manufacturer. | 16 | | (6) Allow a plan sponsor whose coverage is | 17 | | administered by the contracting with a pharmacy benefit | 18 | | manager to request that the pharmacy benefit manager | 19 | | disclose the actual amounts paid by the pharmacy benefit | 20 | | manager to the pharmacy. | 21 | | (7) Provide notice to the plan sponsor and the party | 22 | | contracting with the pharmacy benefit manager of any | 23 | | consideration that the pharmacy benefit manager receives | 24 | | from the manufacturer for dispense as written | 25 | | prescriptions once a generic or biologically similar | 26 | | product becomes available. |
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| 1 | | (c) In order to place a particular prescription drug on a | 2 | | maximum allowable cost list, the pharmacy benefit manager | 3 | | must, at a minimum, ensure that: | 4 | | (1) if the drug is a generically equivalent drug, it | 5 | | is listed as therapeutically equivalent and | 6 | | pharmaceutically equivalent "A" or "B" rated in the United | 7 | | States Food and Drug Administration's most recent version | 8 | | of the "Orange Book" or have an NR or NA rating by | 9 | | Medi-Span, Gold Standard, or a similar rating by a | 10 | | nationally recognized reference; | 11 | | (2) the drug is available for purchase by each | 12 | | pharmacy in the State from national or regional | 13 | | wholesalers operating in Illinois; and | 14 | | (3) the drug is not obsolete. | 15 | | (d) A pharmacy benefit manager is prohibited from limiting | 16 | | a pharmacist's ability to disclose whether the cost-sharing | 17 | | obligation exceeds the retail price for a covered prescription | 18 | | drug, and the availability of a more affordable alternative | 19 | | drug, if one is available in accordance with Section 42 of the | 20 | | Pharmacy Practice Act. | 21 | | (e) A health benefit plan insurer or pharmacy benefit | 22 | | manager shall not require a covered individual an insured to | 23 | | make a payment for a prescription drug at the point of sale in | 24 | | an amount that exceeds the lesser of: | 25 | | (1) the applicable cost-sharing amount; or | 26 | | (2) the retail price of the drug in the absence of |
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| 1 | | prescription drug coverage. | 2 | | (f) Unless required by law, a contract between a pharmacy | 3 | | benefit manager or third-party payer and a 340B entity or 340B | 4 | | pharmacy shall not contain any provision that: | 5 | | (1) distinguishes between drugs purchased through the | 6 | | 340B drug discount program and other drugs when | 7 | | determining reimbursement or reimbursement methodologies, | 8 | | or contains otherwise less favorable payment terms or | 9 | | reimbursement methodologies for 340B entities or 340B | 10 | | pharmacies when compared to similarly situated non-340B | 11 | | entities; | 12 | | (2) imposes any fee, chargeback, or rate adjustment | 13 | | that is not similarly imposed on similarly situated | 14 | | pharmacies that are not 340B entities or 340B pharmacies; | 15 | | (3) imposes any fee, chargeback, or rate adjustment | 16 | | that exceeds the fee, chargeback, or rate adjustment that | 17 | | is not similarly imposed on similarly situated pharmacies | 18 | | that are not 340B entities or 340B pharmacies; | 19 | | (4) prevents or interferes with an individual's choice | 20 | | to receive a covered prescription drug from a 340B entity | 21 | | or 340B pharmacy through any legally permissible means, | 22 | | except that nothing in this paragraph shall prohibit the | 23 | | establishment of differing copayments or other | 24 | | cost-sharing amounts within the health benefit plan for | 25 | | covered individuals persons who acquire covered | 26 | | prescription drugs from a nonpreferred or nonparticipating |
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| 1 | | provider; | 2 | | (5) excludes a 340B entity or 340B pharmacy from a | 3 | | pharmacy network on any basis that includes consideration | 4 | | of whether the 340B entity or 340B pharmacy participates | 5 | | in the 340B drug discount program; | 6 | | (6) prevents a 340B entity or 340B pharmacy from using | 7 | | a drug purchased under the 340B drug discount program; or | 8 | | (7) any other provision that discriminates against a | 9 | | 340B entity or 340B pharmacy by treating the 340B entity | 10 | | or 340B pharmacy differently than non-340B entities or | 11 | | non-340B pharmacies for any reason relating to the | 12 | | entity's participation in the 340B drug discount program. | 13 | | As used in this subsection, "pharmacy benefit manager" and | 14 | | "third-party payer" do not include pharmacy benefit managers | 15 | | and third-party payers acting on behalf of a Medicaid program | 16 | | or an employee welfare benefit plan subject to the federal | 17 | | Employee Retirement Income Security Act of 1974 . | 18 | | (f-5) A pharmacy benefit manager or an affiliate acting on | 19 | | the pharmacy benefit manager's behalf is prohibited from | 20 | | conducting spread pricing in this State. | 21 | | (f-10) A pharmacy benefit manager or an affiliate acting | 22 | | on the pharmacy benefit manager's behalf shall not steer a | 23 | | covered individual. | 24 | | (f-15) A pharmacy benefit manager or an affiliate acting | 25 | | on the pharmacy benefit manager's behalf must remit 100% of | 26 | | rebates and fees to the health benefit plan sponsor, consumer, |
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| 1 | | or employer. Records of rebates and fees remitted from the | 2 | | pharmacy benefit manager or its contracted party shall be | 3 | | retained for 7 years. | 4 | | (f-20) A pharmacy benefit manager may not reimburse a | 5 | | pharmacy or pharmacist for a prescription drug or pharmacy | 6 | | service in an amount less than the national average drug | 7 | | acquisition cost for the prescription drug or pharmacy service | 8 | | at the time the drug is administered or dispensed, plus a | 9 | | professional dispensing fee of $10.49. However, if the | 10 | | national average drug acquisition cost is not available at the | 11 | | time a drug is administered or dispensed, a pharmacy benefit | 12 | | manager may not reimburse in an amount that is less than the | 13 | | wholesale acquisition cost of the drug, as defined in 42 | 14 | | U.S.C. 1395w-3a(c)(6)(B), plus a professional dispensing fee | 15 | | of $10.49. | 16 | | (f-25) A pharmacy benefit manager or an affiliate acting | 17 | | on the pharmacy benefit manager's behalf is prohibited from | 18 | | limiting a covered individual's access to prescription drugs | 19 | | from a pharmacy or pharmacist enrolled with the health benefit | 20 | | plan under the terms offered to all pharmacies in the plan | 21 | | coverage area by unreasonably designating the covered | 22 | | prescription drugs as a specialty drug. | 23 | | (f-30) The contract between the pharmacy benefit manager | 24 | | and the insurer or health benefit plan sponsor must allow and | 25 | | provide for the pharmacy benefit manager's compliance with an | 26 | | audit at least once per calendar year of the rebate and fee |
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| 1 | | records remitted from a pharmacy benefit manager or its | 2 | | contracted party to a health benefit plan. Contracts with | 3 | | rebate aggregators or drug manufactures must be available for | 4 | | audit by health benefit plan sponsors or designated third | 5 | | parties at least once per plan year. Audits shall be performed | 6 | | by an auditor selected by the health benefit plan sponsor. | 7 | | Rebate contracts with rebate aggregators or drug manufactures | 8 | | shall be available for audit by health benefit plan sponsors. | 9 | | (g) A violation of this Section by a pharmacy benefit | 10 | | manager constitutes an unfair or deceptive act or practice in | 11 | | the business of insurance under Section 424. | 12 | | (h) A provision that violates subsection (f) in a | 13 | | contract between a pharmacy benefit manager or a third-party | 14 | | payer and a 340B entity that is entered into, amended, or | 15 | | renewed after July 1, 2022 shall be void and unenforceable. | 16 | | (i)(1) A pharmacy benefit manager may not retaliate | 17 | | against a pharmacist or pharmacy for disclosing information in | 18 | | a court, in an administrative hearing, before a legislative | 19 | | commission or committee, or in any other proceeding, if the | 20 | | pharmacist or pharmacy has reasonable cause to believe that | 21 | | the disclosed information is evidence of a violation of a | 22 | | State or federal law, rule, or regulation. | 23 | | (2) A pharmacy benefit manager may not retaliate against a | 24 | | pharmacist or pharmacy for disclosing information to a | 25 | | government or law enforcement agency, if the pharmacist or | 26 | | pharmacy has reasonable cause to believe that the disclosed |
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| 1 | | information is evidence of a violation of a State or federal | 2 | | law, rule, or regulation. | 3 | | (3) A pharmacist or pharmacy shall make commercially | 4 | | reasonable efforts to limit the disclosure of confidential and | 5 | | proprietary information. | 6 | | (4) Retaliatory actions against a pharmacy or pharmacist | 7 | | include cancellation of, restriction of, or refusal to renew | 8 | | or offer a contract to a pharmacy solely because the pharmacy | 9 | | or pharmacist has: | 10 | | (A) made disclosures of information that the | 11 | | pharmacist or pharmacy has reasonable cause to believe is | 12 | | evidence of a violation of a State or federal law, rule, or | 13 | | regulation; | 14 | | (B) filed complaints with the plan or pharmacy benefit | 15 | | manager; or | 16 | | (C) filed complaints against the plan or pharmacy | 17 | | benefit manager with the Department. | 18 | | (j) This Section applies to contracts entered into or | 19 | | renewed on or after July 1, 2022. | 20 | | (k) This Section applies to any health benefit group or | 21 | | individual policy of accident and health insurance or managed | 22 | | care plan that provides coverage for prescription drugs and | 23 | | that is amended, delivered, issued, or renewed on or after | 24 | | July 1, 2020. | 25 | | (Source: P.A. 102-778, eff. 7-1-22; 103-154, eff. 6-30-23; | 26 | | 103-453, eff. 8-4-23.) |
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| 1 | | (215 ILCS 5/513b1.5 new) | 2 | | Sec. 513b1.5. Pharmacy benefit manager reporting | 3 | | requirements. | 4 | | (a) A pharmacy benefit manager that provides services for | 5 | | a health benefit plan must submit an annual report, by no later | 6 | | than September 1, to the health benefit plan sponsor and | 7 | | issuer and include the following: | 8 | | (1) information collected from drug manufacturers on | 9 | | copayment assistance; | 10 | | (2) a list of drugs covered by the health benefit | 11 | | plan, including details such as the brand name, generic | 12 | | name, number of participants, number of prescription | 13 | | claims, dosage units, dispensing channel used, wholesale | 14 | | acquisition cost, net cost, and total out-of-pocket | 15 | | spending by covered individual; | 16 | | (3) information on each therapeutic class of drugs; | 17 | | (4) the amount received by the health benefit plan in | 18 | | rebates, fees, or discounts related to drug utilization or | 19 | | spending; | 20 | | (5) total gross spending on prescription drugs; | 21 | | (6) total net spending on prescription drugs by the | 22 | | health benefit plan; | 23 | | (7) any compensation paid to brokers, consultants, | 24 | | advisors, or any other individual or firm for referrals, | 25 | | consideration, or retention by the health benefit plan; |
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| 1 | | and | 2 | | (8) an explanation of benefit design parameters | 3 | | encouraging or requiring covered individuals to use | 4 | | affiliated pharmacies, the percentage of prescriptions | 5 | | charged by these pharmacies, and a list of drugs dispensed | 6 | | by affiliated pharmacies with their associated costs. | 7 | | (b) Annual reports submitted pursuant to subsection (a): | 8 | | (1) must be written in plain language to ensure ease | 9 | | of reading and accessibility; | 10 | | (2) may only contain summary health information to | 11 | | ensure plan, coverage, or covered individual information | 12 | | remains private and confidential; | 13 | | (3) upon request by a covered individual, must be | 14 | | available in summary format and provide aggregated | 15 | | information to help covered individuals understand their | 16 | | health benefit plan's prescription drug coverage; and | 17 | | (4) must be filed with the Department no later than | 18 | | September 1 of each year via the System for Electronic | 19 | | Rates & Forms Filing. The filing shall include the summary | 20 | | version of the report described in paragraph (3) of this | 21 | | subsection, which shall be marked for public access. | 22 | | (c) A pharmacy benefit manager may petition the Department | 23 | | for a filing submission extension. The Director may grant or | 24 | | deny the extension within 5 business days. | 25 | | (d) Failure by a pharmacy benefit manager to submit an | 26 | | annual report to the Department may result in a fine levied by |
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| 1 | | the Director not to exceed $1,000 per day. Funds derived from | 2 | | fines levied shall be deposited into the Insurance Producer | 3 | | Administration Fund. Fine information shall be posted on the | 4 | | Department's website. | 5 | | (e) A pharmacy benefit manager found in violation of | 6 | | subsection (a) or paragraph (4) of subsection (b) may request | 7 | | a hearing from the Director within 10 days after being found in | 8 | | violation. | 9 | | (f) Except for the summary versions, the annual reports | 10 | | submitted by pharmacy benefit managers are considered | 11 | | confidential and privileged for all purposes, including for | 12 | | purposes of the Freedom of Information Act, a response to a | 13 | | subpoena, or evidence in a civil action. | 14 | | (g) A copy of an adverse decision against a pharmacy | 15 | | benefit manager for failing to submit an annual report to the | 16 | | Department must be posted to the Department's website. | 17 | | Section 99. Effective date. This Act takes effect July 1, | 18 | | 2024.". |
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