104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1159 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED: 5 ILCS 140/7215 ILCS 5/513b1215 ILCS 5/513b1.5 new Amends the Illinois Insurance Code. Defines "health benefit plan" and other terms. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf is prohibited from conducting spread pricing, from steering a covered individual, and from limiting a covered individual's access to prescription drugs from a pharmacy or pharmacist enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area by unreasonably designating the covered prescription drugs as a specialty drug. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf must remit 100% of rebates and fees to the health benefit plan sponsor, consumer, or employer. Provides that a pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee. Provides that a contract between a pharmacy benefit manager and an insurer or health benefit plan sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at least once per calendar year of the rebate and fee records remitted from a pharmacy benefit manager or its contracted party to a health benefit plan. Provides that provisions concerning pharmacy benefit manager contracts apply to any health benefit plan (instead of any group or individual policy of accident and health insurance or managed care plan) that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020. Requires a pharmacy benefit manager to submit an annual report that includes specified information concerning prescription drugs. Makes other changes. Amends the Freedom of Information Act to make a conforming change. Effective July 1, 2025. LRB104 06506 BAB 16542 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1159 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED: 5 ILCS 140/7215 ILCS 5/513b1215 ILCS 5/513b1.5 new 5 ILCS 140/7 215 ILCS 5/513b1 215 ILCS 5/513b1.5 new Amends the Illinois Insurance Code. Defines "health benefit plan" and other terms. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf is prohibited from conducting spread pricing, from steering a covered individual, and from limiting a covered individual's access to prescription drugs from a pharmacy or pharmacist enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area by unreasonably designating the covered prescription drugs as a specialty drug. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf must remit 100% of rebates and fees to the health benefit plan sponsor, consumer, or employer. Provides that a pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee. Provides that a contract between a pharmacy benefit manager and an insurer or health benefit plan sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at least once per calendar year of the rebate and fee records remitted from a pharmacy benefit manager or its contracted party to a health benefit plan. Provides that provisions concerning pharmacy benefit manager contracts apply to any health benefit plan (instead of any group or individual policy of accident and health insurance or managed care plan) that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020. Requires a pharmacy benefit manager to submit an annual report that includes specified information concerning prescription drugs. Makes other changes. Amends the Freedom of Information Act to make a conforming change. Effective July 1, 2025. LRB104 06506 BAB 16542 b LRB104 06506 BAB 16542 b A BILL FOR
104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1159 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED:
5 ILCS 140/7215 ILCS 5/513b1215 ILCS 5/513b1.5 new 5 ILCS 140/7 215 ILCS 5/513b1 215 ILCS 5/513b1.5 new
5 ILCS 140/7
215 ILCS 5/513b1
215 ILCS 5/513b1.5 new
Amends the Illinois Insurance Code. Defines "health benefit plan" and other terms. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf is prohibited from conducting spread pricing, from steering a covered individual, and from limiting a covered individual's access to prescription drugs from a pharmacy or pharmacist enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area by unreasonably designating the covered prescription drugs as a specialty drug. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf must remit 100% of rebates and fees to the health benefit plan sponsor, consumer, or employer. Provides that a pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee. Provides that a contract between a pharmacy benefit manager and an insurer or health benefit plan sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at least once per calendar year of the rebate and fee records remitted from a pharmacy benefit manager or its contracted party to a health benefit plan. Provides that provisions concerning pharmacy benefit manager contracts apply to any health benefit plan (instead of any group or individual policy of accident and health insurance or managed care plan) that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020. Requires a pharmacy benefit manager to submit an annual report that includes specified information concerning prescription drugs. Makes other changes. Amends the Freedom of Information Act to make a conforming change. Effective July 1, 2025.
LRB104 06506 BAB 16542 b LRB104 06506 BAB 16542 b
LRB104 06506 BAB 16542 b
A BILL FOR
HB1159LRB104 06506 BAB 16542 b HB1159 LRB104 06506 BAB 16542 b
HB1159 LRB104 06506 BAB 16542 b
1 AN ACT concerning regulation.
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 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
17 disclosure by federal or State law or rules and
18 regulations implementing federal or State law.
19 (b) Private information, unless disclosure is required
20 by another provision of this Act, a State or federal law,
21 or a court order.
22 (b-5) Files, documents, and other data or databases
23 maintained by one or more law enforcement agencies and
104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1159 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED:
5 ILCS 140/7215 ILCS 5/513b1215 ILCS 5/513b1.5 new 5 ILCS 140/7 215 ILCS 5/513b1 215 ILCS 5/513b1.5 new
5 ILCS 140/7
215 ILCS 5/513b1
215 ILCS 5/513b1.5 new
Amends the Illinois Insurance Code. Defines "health benefit plan" and other terms. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf is prohibited from conducting spread pricing, from steering a covered individual, and from limiting a covered individual's access to prescription drugs from a pharmacy or pharmacist enrolled with the health benefit plan under the terms offered to all pharmacies in the plan coverage area by unreasonably designating the covered prescription drugs as a specialty drug. Provides that a pharmacy benefit manager or an affiliate acting on the pharmacy benefit manager's behalf must remit 100% of rebates and fees to the health benefit plan sponsor, consumer, or employer. Provides that a pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee. Provides that a contract between a pharmacy benefit manager and an insurer or health benefit plan sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at least once per calendar year of the rebate and fee records remitted from a pharmacy benefit manager or its contracted party to a health benefit plan. Provides that provisions concerning pharmacy benefit manager contracts apply to any health benefit plan (instead of any group or individual policy of accident and health insurance or managed care plan) that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020. Requires a pharmacy benefit manager to submit an annual report that includes specified information concerning prescription drugs. Makes other changes. Amends the Freedom of Information Act to make a conforming change. Effective July 1, 2025.
LRB104 06506 BAB 16542 b LRB104 06506 BAB 16542 b
LRB104 06506 BAB 16542 b
A BILL FOR
5 ILCS 140/7
215 ILCS 5/513b1
215 ILCS 5/513b1.5 new
LRB104 06506 BAB 16542 b
HB1159 LRB104 06506 BAB 16542 b
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1 specifically designed to provide information to one or
2 more law enforcement agencies regarding the physical or
3 mental status of one or more individual subjects.
4 (c) Personal information contained within public
5 records, the disclosure of which would constitute a
6 clearly unwarranted invasion of personal privacy, unless
7 the disclosure is consented to in writing by the
8 individual subjects of the information. "Unwarranted
9 invasion of personal privacy" means the disclosure of
10 information that is highly personal or objectionable to a
11 reasonable person and in which the subject's right to
12 privacy outweighs any legitimate public interest in
13 obtaining the information. The disclosure of information
14 that bears on the public duties of public employees and
15 officials shall not be considered an invasion of personal
16 privacy.
17 (d) Records in the possession of any public body
18 created in the course of administrative enforcement
19 proceedings, and any law enforcement or correctional
20 agency for law enforcement purposes, but only to the
21 extent that disclosure would:
22 (i) interfere with pending or actually and
23 reasonably contemplated law enforcement proceedings
24 conducted by any law enforcement or correctional
25 agency that is the recipient of the request;
26 (ii) interfere with active administrative
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1 enforcement proceedings conducted by the public body
2 that is the recipient of the request;
3 (iii) create a substantial likelihood that a
4 person will be deprived of a fair trial or an impartial
5 hearing;
6 (iv) unavoidably disclose the identity of a
7 confidential source, confidential information
8 furnished only by the confidential source, or persons
9 who file complaints with or provide information to
10 administrative, investigative, law enforcement, or
11 penal agencies; except that the identities of
12 witnesses to traffic crashes, traffic crash reports,
13 and rescue reports shall be provided by agencies of
14 local government, except when disclosure would
15 interfere with an active criminal investigation
16 conducted by the agency that is the recipient of the
17 request;
18 (v) disclose unique or specialized investigative
19 techniques other than those generally used and known
20 or disclose internal documents of correctional
21 agencies related to detection, observation, or
22 investigation of incidents of crime or misconduct, and
23 disclosure would result in demonstrable harm to the
24 agency or public body that is the recipient of the
25 request;
26 (vi) endanger the life or physical safety of law
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1 enforcement personnel or any other person; or
2 (vii) obstruct an ongoing criminal investigation
3 by the agency that is the recipient of the request.
4 (d-5) A law enforcement record created for law
5 enforcement purposes and contained in a shared electronic
6 record management system if the law enforcement agency
7 that is the recipient of the request did not create the
8 record, did not participate in or have a role in any of the
9 events which are the subject of the record, and only has
10 access to the record through the shared electronic record
11 management system.
12 (d-6) Records contained in the Officer Professional
13 Conduct Database under Section 9.2 of the Illinois Police
14 Training Act, except to the extent authorized under that
15 Section. This includes the documents supplied to the
16 Illinois Law Enforcement Training Standards Board from the
17 Illinois State Police and Illinois State Police Merit
18 Board.
19 (d-7) Information gathered or records created from the
20 use of automatic license plate readers in connection with
21 Section 2-130 of the Illinois Vehicle Code.
22 (e) Records that relate to or affect the security of
23 correctional institutions and detention facilities.
24 (e-5) Records requested by persons committed to the
25 Department of Corrections, Department of Human Services
26 Division of Mental Health, or a county jail if those
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1 materials are available in the library of the correctional
2 institution or facility or jail where the inmate is
3 confined.
4 (e-6) Records requested by persons committed to the
5 Department of Corrections, Department of Human Services
6 Division of Mental Health, or a county jail if those
7 materials include records from staff members' personnel
8 files, staff rosters, or other staffing assignment
9 information.
10 (e-7) Records requested by persons committed to the
11 Department of Corrections or Department of Human Services
12 Division of Mental Health if those materials are available
13 through an administrative request to the Department of
14 Corrections or Department of Human Services Division of
15 Mental Health.
16 (e-8) Records requested by a person committed to the
17 Department of Corrections, Department of Human Services
18 Division of Mental Health, or a county jail, the
19 disclosure of which would result in the risk of harm to any
20 person or the risk of an escape from a jail or correctional
21 institution or facility.
22 (e-9) Records requested by a person in a county jail
23 or committed to the Department of Corrections or
24 Department of Human Services Division of Mental Health,
25 containing personal information pertaining to the person's
26 victim or the victim's family, including, but not limited
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1 to, a victim's home address, home telephone number, work
2 or school address, work telephone number, social security
3 number, or any other identifying information, except as
4 may be relevant to a requester's current or potential case
5 or claim.
6 (e-10) Law enforcement records of other persons
7 requested by a person committed to the Department of
8 Corrections, Department of Human Services Division of
9 Mental Health, or a county jail, including, but not
10 limited to, arrest and booking records, mug shots, and
11 crime scene photographs, except as these records may be
12 relevant to the requester's current or potential case or
13 claim.
14 (f) Preliminary drafts, notes, recommendations,
15 memoranda, and other records in which opinions are
16 expressed, or policies or actions are formulated, except
17 that a specific record or relevant portion of a record
18 shall not be exempt when the record is publicly cited and
19 identified by the head of the public body. The exemption
20 provided in this paragraph (f) extends to all those
21 records of officers and agencies of the General Assembly
22 that pertain to the preparation of legislative documents.
23 (g) Trade secrets and commercial or financial
24 information obtained from a person or business where the
25 trade secrets or commercial or financial information are
26 furnished under a claim that they are proprietary,
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1 privileged, or confidential, and that disclosure of the
2 trade secrets or commercial or financial information would
3 cause competitive harm to the person or business, and only
4 insofar as the claim directly applies to the records
5 requested.
6 The information included under this exemption includes
7 all trade secrets and commercial or financial information
8 obtained by a public body, including a public pension
9 fund, from a private equity fund or a privately held
10 company within the investment portfolio of a private
11 equity fund as a result of either investing or evaluating
12 a potential investment of public funds in a private equity
13 fund. The exemption contained in this item does not apply
14 to the aggregate financial performance information of a
15 private equity fund, nor to the identity of the fund's
16 managers or general partners. The exemption contained in
17 this item does not apply to the identity of a privately
18 held company within the investment portfolio of a private
19 equity fund, unless the disclosure of the identity of a
20 privately held company may cause competitive harm.
21 Nothing contained in this paragraph (g) shall be
22 construed to prevent a person or business from consenting
23 to disclosure.
24 (h) Proposals and bids for any contract, grant, or
25 agreement, including information which if it were
26 disclosed would frustrate procurement or give an advantage
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1 to any person proposing to enter into a contractor
2 agreement with the body, until an award or final selection
3 is made. Information prepared by or for the body in
4 preparation of a bid solicitation shall be exempt until an
5 award or final selection is made.
6 (i) Valuable formulae, computer geographic systems,
7 designs, drawings, and research data obtained or produced
8 by any public body when disclosure could reasonably be
9 expected to produce private gain or public loss. The
10 exemption for "computer geographic systems" provided in
11 this paragraph (i) does not extend to requests made by
12 news media as defined in Section 2 of this Act when the
13 requested information is not otherwise exempt and the only
14 purpose of the request is to access and disseminate
15 information regarding the health, safety, welfare, or
16 legal rights of the general public.
17 (j) The following information pertaining to
18 educational matters:
19 (i) test questions, scoring keys, and other
20 examination data used to administer an academic
21 examination;
22 (ii) information received by a primary or
23 secondary school, college, or university under its
24 procedures for the evaluation of faculty members by
25 their academic peers;
26 (iii) information concerning a school or
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1 university's adjudication of student disciplinary
2 cases, but only to the extent that disclosure would
3 unavoidably reveal the identity of the student; and
4 (iv) course materials or research materials used
5 by faculty members.
6 (k) Architects' plans, engineers' technical
7 submissions, and other construction related technical
8 documents for projects not constructed or developed in
9 whole or in part with public funds and the same for
10 projects constructed or developed with public funds,
11 including, but not limited to, power generating and
12 distribution stations and other transmission and
13 distribution facilities, water treatment facilities,
14 airport facilities, sport stadiums, convention centers,
15 and all government owned, operated, or occupied buildings,
16 but only to the extent that disclosure would compromise
17 security.
18 (l) Minutes of meetings of public bodies closed to the
19 public as provided in the Open Meetings Act until the
20 public body makes the minutes available to the public
21 under Section 2.06 of the Open Meetings Act.
22 (m) Communications between a public body and an
23 attorney or auditor representing the public body that
24 would not be subject to discovery in litigation, and
25 materials prepared or compiled by or for a public body in
26 anticipation of a criminal, civil, or administrative
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1 proceeding upon the request of an attorney advising the
2 public body, and materials prepared or compiled with
3 respect to internal audits of public bodies.
4 (n) Records relating to a public body's adjudication
5 of employee grievances or disciplinary cases; however,
6 this exemption shall not extend to the final outcome of
7 cases in which discipline is imposed.
8 (o) Administrative or technical information associated
9 with automated data processing operations, including, but
10 not limited to, software, operating protocols, computer
11 program abstracts, file layouts, source listings, object
12 modules, load modules, user guides, documentation
13 pertaining to all logical and physical design of
14 computerized systems, employee manuals, and any other
15 information that, if disclosed, would jeopardize the
16 security of the system or its data or the security of
17 materials exempt under this Section.
18 (p) Records relating to collective negotiating matters
19 between public bodies and their employees or
20 representatives, except that any final contract or
21 agreement shall be subject to inspection and copying.
22 (q) Test questions, scoring keys, and other
23 examination data used to determine the qualifications of
24 an applicant for a license or employment.
25 (r) The records, documents, and information relating
26 to real estate purchase negotiations until those
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1 negotiations have been completed or otherwise terminated.
2 With regard to a parcel involved in a pending or actually
3 and reasonably contemplated eminent domain proceeding
4 under the Eminent Domain Act, records, documents, and
5 information relating to that parcel shall be exempt except
6 as may be allowed under discovery rules adopted by the
7 Illinois Supreme Court. The records, documents, and
8 information relating to a real estate sale shall be exempt
9 until a sale is consummated.
10 (s) Any and all proprietary information and records
11 related to the operation of an intergovernmental risk
12 management association or self-insurance pool or jointly
13 self-administered health and accident cooperative or pool.
14 Insurance or self-insurance (including any
15 intergovernmental risk management association or
16 self-insurance pool) claims, loss or risk management
17 information, records, data, advice, or communications.
18 (t) Information contained in or related to
19 examination, operating, or condition reports prepared by,
20 on behalf of, or for the use of a public body responsible
21 for the regulation or supervision of financial
22 institutions, insurance companies, or pharmacy benefit
23 managers, unless disclosure is otherwise required by State
24 law.
25 (u) Information that would disclose or might lead to
26 the disclosure of secret or confidential information,
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1 codes, algorithms, programs, or private keys intended to
2 be used to create electronic signatures under the Uniform
3 Electronic Transactions Act.
4 (v) Vulnerability assessments, security measures, and
5 response policies or plans that are designed to identify,
6 prevent, or respond to potential attacks upon a
7 community's population or systems, facilities, or
8 installations, but only to the extent that disclosure
9 could reasonably be expected to expose the vulnerability
10 or jeopardize the effectiveness of the measures, policies,
11 or plans, or the safety of the personnel who implement
12 them or the public. Information exempt under this item may
13 include such things as details pertaining to the
14 mobilization or deployment of personnel or equipment, to
15 the operation of communication systems or protocols, to
16 cybersecurity vulnerabilities, or to tactical operations.
17 (w) (Blank).
18 (x) Maps and other records regarding the location or
19 security of generation, transmission, distribution,
20 storage, gathering, treatment, or switching facilities
21 owned by a utility, by a power generator, or by the
22 Illinois Power Agency.
23 (y) Information contained in or related to proposals,
24 bids, or negotiations related to electric power
25 procurement under Section 1-75 of the Illinois Power
26 Agency Act and Section 16-111.5 of the Public Utilities
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1 Act that is determined to be confidential and proprietary
2 by the Illinois Power Agency or by the Illinois Commerce
3 Commission.
4 (z) Information about students exempted from
5 disclosure under Section 10-20.38 or 34-18.29 of the
6 School Code, and information about undergraduate students
7 enrolled at an institution of higher education exempted
8 from disclosure under Section 25 of the Illinois Credit
9 Card Marketing Act of 2009.
10 (aa) Information the disclosure of which is exempted
11 under the Viatical Settlements Act of 2009.
12 (bb) Records and information provided to a mortality
13 review team and records maintained by a mortality review
14 team appointed under the Department of Juvenile Justice
15 Mortality Review Team Act.
16 (cc) Information regarding interments, entombments, or
17 inurnments of human remains that are submitted to the
18 Cemetery Oversight Database under the Cemetery Care Act or
19 the Cemetery Oversight Act, whichever is applicable.
20 (dd) Correspondence and records (i) that may not be
21 disclosed under Section 11-9 of the Illinois Public Aid
22 Code or (ii) that pertain to appeals under Section 11-8 of
23 the Illinois Public Aid Code.
24 (ee) The names, addresses, or other personal
25 information of persons who are minors and are also
26 participants and registrants in programs of park
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1 districts, forest preserve districts, conservation
2 districts, recreation agencies, and special recreation
3 associations.
4 (ff) The names, addresses, or other personal
5 information of participants and registrants in programs of
6 park districts, forest preserve districts, conservation
7 districts, recreation agencies, and special recreation
8 associations where such programs are targeted primarily to
9 minors.
10 (gg) Confidential information described in Section
11 1-100 of the Illinois Independent Tax Tribunal Act of
12 2012.
13 (hh) The report submitted to the State Board of
14 Education by the School Security and Standards Task Force
15 under item (8) of subsection (d) of Section 2-3.160 of the
16 School Code and any information contained in that report.
17 (ii) Records requested by persons committed to or
18 detained by the Department of Human Services under the
19 Sexually Violent Persons Commitment Act or committed to
20 the Department of Corrections under the Sexually Dangerous
21 Persons Act if those materials: (i) are available in the
22 library of the facility where the individual is confined;
23 (ii) include records from staff members' personnel files,
24 staff rosters, or other staffing assignment information;
25 or (iii) are available through an administrative request
26 to the Department of Human Services or the Department of
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1 Corrections.
2 (jj) Confidential information described in Section
3 5-535 of the Civil Administrative Code of Illinois.
4 (kk) The public body's credit card numbers, debit card
5 numbers, bank account numbers, Federal Employer
6 Identification Number, security code numbers, passwords,
7 and similar account information, the disclosure of which
8 could result in identity theft or impression or defrauding
9 of a governmental entity or a person.
10 (ll) Records concerning the work of the threat
11 assessment team of a school district, including, but not
12 limited to, any threat assessment procedure under the
13 School Safety Drill Act and any information contained in
14 the procedure.
15 (mm) Information prohibited from being disclosed under
16 subsections (a) and (b) of Section 15 of the Student
17 Confidential Reporting Act.
18 (nn) Proprietary information submitted to the
19 Environmental Protection Agency under the Drug Take-Back
20 Act.
21 (oo) Records described in subsection (f) of Section
22 3-5-1 of the Unified Code of Corrections.
23 (pp) Any and all information regarding burials,
24 interments, or entombments of human remains as required to
25 be reported to the Department of Natural Resources
26 pursuant either to the Archaeological and Paleontological
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1 Resources Protection Act or the Human Remains Protection
2 Act.
3 (qq) Reports described in subsection (e) of Section
4 16-15 of the Abortion Care Clinical Training Program Act.
5 (rr) Information obtained by a certified local health
6 department under the Access to Public Health Data Act.
7 (ss) For a request directed to a public body that is
8 also a HIPAA-covered entity, all information that is
9 protected health information, including demographic
10 information, that may be contained within or extracted
11 from any record held by the public body in compliance with
12 State and federal medical privacy laws and regulations,
13 including, but not limited to, the Health Insurance
14 Portability and Accountability Act and its regulations, 45
15 CFR Parts 160 and 164. As used in this paragraph,
16 "HIPAA-covered entity" has the meaning given to the term
17 "covered entity" in 45 CFR 160.103 and "protected health
18 information" has the meaning given to that term in 45 CFR
19 160.103.
20 (tt) Proposals or bids submitted by engineering
21 consultants in response to requests for proposal or other
22 competitive bidding requests by the Department of
23 Transportation or the Illinois Toll Highway Authority.
24 (uu) Annual reports submitted by pharmacy benefit
25 managers under Section 513b1.5 of the Illinois Insurance
26 Code, except for the summary versions of the reports under
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1 paragraph (3) of subsection (b) of Section 513b1.5 of the
2 Illinois Insurance Code.
3 (1.5) Any information exempt from disclosure under the
4 Judicial Privacy Act shall be redacted from public records
5 prior to disclosure under this Act.
6 (2) A public record that is not in the possession of a
7 public body but is in the possession of a party with whom the
8 agency has contracted to perform a governmental function on
9 behalf of the public body, and that directly relates to the
10 governmental function and is not otherwise exempt under this
11 Act, shall be considered a public record of the public body,
12 for purposes of this Act.
13 (3) This Section does not authorize withholding of
14 information or limit the availability of records to the
15 public, except as stated in this Section or otherwise provided
16 in this Act.
17 (Source: P.A. 102-38, eff. 6-25-21; 102-558, eff. 8-20-21;
18 102-694, eff. 1-7-22; 102-752, eff. 5-6-22; 102-753, eff.
19 1-1-23; 102-776, eff. 1-1-23; 102-791, eff. 5-13-22; 102-982,
20 eff. 7-1-23; 102-1055, eff. 6-10-22; 103-154, eff. 6-30-23;
21 103-423, eff. 1-1-24; 103-446, eff. 8-4-23; 103-462, eff.
22 8-4-23; 103-540, eff. 1-1-24; 103-554, eff. 1-1-24; 103-605,
23 eff. 7-1-24; 103-865, eff. 1-1-25.)
24 Section 10. The Illinois Insurance Code is amended by
25 changing Section 513b1 and by adding Section 513b1.5 as
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1 follows:
2 (215 ILCS 5/513b1)
3 Sec. 513b1. Pharmacy benefit manager contracts.
4 (a) As used in this Section:
5 "340B drug discount program" means the program established
6 under Section 340B of the federal Public Health Service Act,
7 42 U.S.C. 256b.
8 "340B entity" means a covered entity as defined in 42
9 U.S.C. 256b(a)(4) authorized to participate in the 340B drug
10 discount program.
11 "340B pharmacy" means any pharmacy used to dispense 340B
12 drugs for a covered entity, whether entity-owned or external.
13 "Biological product" has the meaning ascribed to that term
14 in Section 19.5 of the Pharmacy Practice Act.
15 "Covered individual" means a member, participant,
16 enrollee, contract holder, policyholder, or beneficiary of a
17 health benefit plan who is provided a prescription drug
18 benefit by the health benefit plan.
19 "Health benefit plan" means a policy, contract,
20 certificate, or agreement entered into, offered, or issued by
21 an insurer to provide, deliver, arrange for, pay for, or
22 reimburse any of the costs of physical, mental, or behavioral
23 health care services. "Health benefit plan" does not include
24 Medicaid managed care organizations, as defined in Section
25 5-30.1 of the Illinois Public Aid Code, or employee welfare
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1 benefit plans subject to the federal Employee Retirement
2 Income Security Act of 1974.
3 "Maximum allowable cost" means the maximum amount that a
4 pharmacy benefit manager will reimburse a pharmacy for the
5 cost of a drug.
6 "Maximum allowable cost list" means a list of drugs for
7 which a maximum allowable cost has been established by a
8 pharmacy benefit manager.
9 "Pharmacy benefit manager" means a person, business, or
10 entity, including a wholly or partially owned or controlled
11 subsidiary of a pharmacy benefit manager, that provides claims
12 processing services or other prescription drug or device
13 services, or both, for health benefit plans.
14 "Rebate aggregator" means a person or entity that
15 negotiates rebates, discounts, or other fees attributable to
16 usage by covered individuals with drug manufacturers on behalf
17 of pharmacy benefit managers or their clients and may also be
18 involved in contracts that entitle the rebate aggregator or
19 its client to receive rebates, discounts, or other fees
20 attributable to usage by covered individuals from drug
21 manufacturers based on drug utilization or administration.
22 "Retail price" means the price an individual without
23 prescription drug coverage would pay at a retail pharmacy, not
24 including a pharmacist dispensing fee.
25 "Spread pricing" means the model of prescription drug
26 pricing in which the pharmacy benefit manager charges a health
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1 benefit plan a contracted price for prescription drugs and the
2 contracted price for the prescription drugs differs from the
3 amount the pharmacy benefit manager directly or indirectly
4 pays the pharmacist or pharmacy for pharmacist services.
5 "Steer" includes, but is not limited to:
6 (1) requiring a covered individual to use only a
7 pharmacy, including a mail-order pharmacy, in which the
8 pharmacy benefit manager maintains an ownership interest
9 or control;
10 (2) offering or implementing a plan design that
11 encourages a covered individual to use a pharmacy in which
12 the pharmacy benefit manager maintains an ownership
13 interest or control, if such plan design increases costs
14 for the covered individual, including requiring a covered
15 individual to pay full costs for a prescription if the
16 covered individual chooses not to use a pharmacy owned or
17 controlled by the pharmacy benefit manager;
18 (3) reimbursing a pharmacy or pharmacist for a
19 pharmaceutical product or pharmacist service in an amount
20 less than the amount that the pharmacy benefit manager
21 reimburses itself or an affiliate for providing the same
22 product or services, unless the pharmacy or pharmacist
23 contractually agrees to a lower reimbursement amount; or
24 (4) any other actions determined by the Department by
25 rule.
26 "Third-party payer" means any entity that pays for
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1 prescription drugs on behalf of a patient other than a health
2 care provider or sponsor of a plan subject to regulation under
3 Medicare Part D, 42 U.S.C. 1395w-101 et seq.
4 (b) A contract between a health insurer and a pharmacy
5 benefit manager must require that the pharmacy benefit
6 manager:
7 (1) Update maximum allowable cost pricing information
8 at least every 7 calendar days.
9 (2) Maintain a process that will, in a timely manner,
10 eliminate drugs from maximum allowable cost lists or
11 modify drug prices to remain consistent with changes in
12 pricing data used in formulating maximum allowable cost
13 prices and product availability.
14 (3) Provide access to its maximum allowable cost list
15 to each pharmacy or pharmacy services administrative
16 organization subject to the maximum allowable cost list.
17 Access may include a real-time pharmacy website portal to
18 be able to view the maximum allowable cost list. As used in
19 this Section, "pharmacy services administrative
20 organization" means an entity operating within the State
21 that contracts with independent pharmacies to conduct
22 business on their behalf with third-party payers. A
23 pharmacy services administrative organization may provide
24 administrative services to pharmacies and negotiate and
25 enter into contracts with third-party payers or pharmacy
26 benefit managers on behalf of pharmacies.
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1 (4) Provide a process by which a contracted pharmacy
2 can appeal the provider's reimbursement for a drug subject
3 to maximum allowable cost pricing. The appeals process
4 must, at a minimum, include the following:
5 (A) A requirement that a contracted pharmacy has
6 14 calendar days after the applicable fill date to
7 appeal a maximum allowable cost if the reimbursement
8 for the drug is less than the net amount that the
9 network provider paid to the supplier of the drug.
10 (B) A requirement that a pharmacy benefit manager
11 must respond to a challenge within 14 calendar days of
12 the contracted pharmacy making the claim for which the
13 appeal has been submitted.
14 (C) A telephone number and e-mail address or
15 website to network providers, at which the provider
16 can contact the pharmacy benefit manager to process
17 and submit an appeal.
18 (D) A requirement that, if an appeal is denied,
19 the pharmacy benefit manager must provide the reason
20 for the denial and the name and the national drug code
21 number from national or regional wholesalers.
22 (E) A requirement that, if an appeal is sustained,
23 the pharmacy benefit manager must make an adjustment
24 in the drug price effective the date the challenge is
25 resolved and make the adjustment applicable to all
26 similarly situated network pharmacy providers, as
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1 determined by the managed care organization or
2 pharmacy benefit manager.
3 (5) Allow a plan sponsor whose coverage is
4 administered by the contracting with a pharmacy benefit
5 manager an annual right to audit compliance with the terms
6 of the contract by the pharmacy benefit manager,
7 including, but not limited to, full disclosure of any and
8 all rebate amounts secured, whether product specific or
9 generalized rebates, that were provided to the pharmacy
10 benefit manager by a pharmaceutical manufacturer.
11 (6) Allow a plan sponsor whose coverage is
12 administered by the contracting with a pharmacy benefit
13 manager to request that the pharmacy benefit manager
14 disclose the actual amounts paid by the pharmacy benefit
15 manager to the pharmacy.
16 (7) Provide notice to the plan sponsor and the party
17 contracting with the pharmacy benefit manager of any
18 consideration that the pharmacy benefit manager receives
19 from the manufacturer for dispense as written
20 prescriptions once a generic or biologically similar
21 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 benefit plan insurer or pharmacy benefit
17 manager shall not require a covered individual an insured to
18 make a payment for a prescription drug at the point of sale in
19 an amount that exceeds the lesser of:
20 (1) the applicable cost-sharing amount; or
21 (2) the retail price of the drug in the absence of
22 prescription drug coverage.
23 (f) Unless required by law, a contract between a pharmacy
24 benefit manager or third-party payer and a 340B entity or 340B
25 pharmacy shall not contain any provision that:
26 (1) distinguishes between drugs purchased through the
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1 340B drug discount program and other drugs when
2 determining reimbursement or reimbursement methodologies,
3 or contains otherwise less favorable payment terms or
4 reimbursement methodologies for 340B entities or 340B
5 pharmacies when compared to similarly situated non-340B
6 entities;
7 (2) imposes any fee, chargeback, or rate adjustment
8 that is not similarly imposed on similarly situated
9 pharmacies that are not 340B entities or 340B pharmacies;
10 (3) imposes any fee, chargeback, or rate adjustment
11 that exceeds the fee, chargeback, or rate adjustment that
12 is not similarly imposed on similarly situated pharmacies
13 that are not 340B entities or 340B pharmacies;
14 (4) prevents or interferes with an individual's choice
15 to receive a covered prescription drug from a 340B entity
16 or 340B pharmacy through any legally permissible means,
17 except that nothing in this paragraph shall prohibit the
18 establishment of differing copayments or other
19 cost-sharing amounts within the health benefit plan for
20 covered individuals persons who acquire covered
21 prescription drugs from a nonpreferred or nonparticipating
22 provider;
23 (5) excludes a 340B entity or 340B pharmacy from a
24 pharmacy network on any basis that includes consideration
25 of whether the 340B entity or 340B pharmacy participates
26 in the 340B drug discount program;
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1 (6) prevents a 340B entity or 340B pharmacy from using
2 a drug purchased under the 340B drug discount program; or
3 (7) any other provision that discriminates against a
4 340B entity or 340B pharmacy by treating the 340B entity
5 or 340B pharmacy differently than non-340B entities or
6 non-340B pharmacies for any reason relating to the
7 entity's participation in the 340B drug discount program.
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 or an employee welfare benefit plan subject to the federal
12 Employee Retirement Income Security Act of 1974.
13 (f-5) A pharmacy benefit manager or an affiliate acting on
14 the pharmacy benefit manager's behalf is prohibited from
15 conducting spread pricing in this State.
16 (f-10) A pharmacy benefit manager or an affiliate acting
17 on the pharmacy benefit manager's behalf shall not steer a
18 covered individual.
19 (f-15) A pharmacy benefit manager or an affiliate acting
20 on the pharmacy benefit manager's behalf must remit 100% of
21 rebates and fees to the health benefit plan sponsor, consumer,
22 or employer. Records of rebates and fees remitted from the
23 pharmacy benefit manager or its contracted party shall be
24 retained for 7 years.
25 (f-20) A pharmacy benefit manager may not reimburse a
26 pharmacy or pharmacist for a prescription drug or pharmacy
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1 service in an amount less than the national average drug
2 acquisition cost for the prescription drug or pharmacy service
3 at the time the drug is administered or dispensed, plus a
4 professional dispensing fee of $10.49. However, if the
5 national average drug acquisition cost is not available at the
6 time a drug is administered or dispensed, a pharmacy benefit
7 manager may not reimburse in an amount that is less than the
8 wholesale acquisition cost of the drug, as defined in 42
9 U.S.C. 1395w-3a(c)(6)(B), plus a professional dispensing fee
10 of $10.49.
11 (f-25) A pharmacy benefit manager or an affiliate acting
12 on the pharmacy benefit manager's behalf is prohibited from
13 limiting a covered individual's access to prescription drugs
14 from a pharmacy or pharmacist enrolled with the health benefit
15 plan under the terms offered to all pharmacies in the plan
16 coverage area by unreasonably designating the covered
17 prescription drugs as a specialty drug.
18 (f-30) The contract between the pharmacy benefit manager
19 and the insurer or health benefit plan sponsor must allow and
20 provide for the pharmacy benefit manager's compliance with an
21 audit at least once per calendar year of the rebate and fee
22 records remitted from a pharmacy benefit manager or its
23 contracted party to a health benefit plan. Contracts with
24 rebate aggregators or drug manufactures must be available for
25 audit by health benefit plan sponsors or designated third
26 parties at least once per plan year. Audits shall be performed
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1 by an auditor selected by the health benefit plan sponsor.
2 Rebate contracts with rebate aggregators or drug manufactures
3 shall be available for audit by health benefit plan sponsors.
4 (g) A violation of this Section by a pharmacy benefit
5 manager constitutes an unfair or deceptive act or practice in
6 the business of insurance under Section 424.
7 (h) A provision that violates subsection (f) in a
8 contract between a pharmacy benefit manager or a third-party
9 payer and a 340B entity that is entered into, amended, or
10 renewed after July 1, 2022 shall be void and unenforceable.
11 (i)(1) A pharmacy benefit manager may not retaliate
12 against a pharmacist or pharmacy for disclosing information in
13 a court, in an administrative hearing, before a legislative
14 commission or committee, or in any other proceeding, if the
15 pharmacist or pharmacy has reasonable cause to believe that
16 the disclosed information is evidence of a violation of a
17 State or federal law, rule, or regulation.
18 (2) A pharmacy benefit manager may not retaliate against a
19 pharmacist or pharmacy for disclosing information to a
20 government or law enforcement agency, if the pharmacist or
21 pharmacy has reasonable cause to believe that the disclosed
22 information is evidence of a violation of a State or federal
23 law, rule, or regulation.
24 (3) A pharmacist or pharmacy shall make commercially
25 reasonable efforts to limit the disclosure of confidential and
26 proprietary information.
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1 (4) Retaliatory actions against a pharmacy or pharmacist
2 include cancellation of, restriction of, or refusal to renew
3 or offer a contract to a pharmacy solely because the pharmacy
4 or pharmacist has:
5 (A) made disclosures of information that the
6 pharmacist or pharmacy has reasonable cause to believe is
7 evidence of a violation of a State or federal law, rule, or
8 regulation;
9 (B) filed complaints with the plan or pharmacy benefit
10 manager; or
11 (C) filed complaints against the plan or pharmacy
12 benefit manager with the Department.
13 (j) This Section applies to contracts entered into or
14 renewed on or after July 1, 2022.
15 (k) This Section applies to any health benefit group or
16 individual policy of accident and health insurance or managed
17 care plan that provides coverage for prescription drugs and
18 that is amended, delivered, issued, or renewed on or after
19 July 1, 2020.
20 (Source: P.A. 102-778, eff. 7-1-22; 103-154, eff. 6-30-23;
21 103-453, eff. 8-4-23.)
22 (215 ILCS 5/513b1.5 new)
23 Sec. 513b1.5. Pharmacy benefit manager reporting
24 requirements.
25 (a) A pharmacy benefit manager that provides services for
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1 a health benefit plan must submit an annual report, by no later
2 than September 1, to the health benefit plan sponsor and
3 issuer and include the following:
4 (1) information collected from drug manufacturers on
5 copayment assistance;
6 (2) a list of drugs covered by the health benefit
7 plan, including details such as the brand name, generic
8 name, number of participants, number of prescription
9 claims, dosage units, dispensing channel used, wholesale
10 acquisition cost, net cost, and total out-of-pocket
11 spending by covered individual;
12 (3) information on each therapeutic class of drugs;
13 (4) the amount received by the health benefit plan in
14 rebates, fees, or discounts related to drug utilization or
15 spending;
16 (5) total gross spending on prescription drugs;
17 (6) total net spending on prescription drugs by the
18 health benefit plan;
19 (7) any compensation paid to brokers, consultants,
20 advisors, or any other individual or firm for referrals,
21 consideration, or retention by the health benefit plan;
22 and
23 (8) an explanation of benefit design parameters
24 encouraging or requiring covered individuals to use
25 affiliated pharmacies, the percentage of prescriptions
26 charged by these pharmacies, and a list of drugs dispensed
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1 by affiliated pharmacies with their associated costs.
2 (b) Annual reports submitted pursuant to subsection (a):
3 (1) must be written in plain language to ensure ease
4 of reading and accessibility;
5 (2) may only contain summary health information to
6 ensure plan, coverage, or covered individual information
7 remains private and confidential;
8 (3) upon request by a covered individual, must be
9 available in summary format and provide aggregated
10 information to help covered individuals understand their
11 health benefit plan's prescription drug coverage; and
12 (4) must be filed with the Department no later than
13 September 1 of each year via the System for Electronic
14 Rates & Forms Filing. The filing shall include the summary
15 version of the report described in paragraph (3) of this
16 subsection, which shall be marked for public access.
17 (c) A pharmacy benefit manager may petition the Department
18 for a filing submission extension. The Director may grant or
19 deny the extension within 5 business days after receiving the
20 petition.
21 (d) Failure by a pharmacy benefit manager to submit an
22 annual report to the Department may result in a fine levied by
23 the Director not to exceed $1,000 per day. Funds derived from
24 fines levied shall be deposited into the Insurance Producer
25 Administration Fund. Fine information shall be posted on the
26 Department's website.
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1 (e) A pharmacy benefit manager found in violation of
2 subsection (a) or paragraph (4) of subsection (b) may request
3 a hearing from the Director within 10 days after being found in
4 violation.
5 (f) Except for the summary versions, the annual reports
6 submitted by pharmacy benefit managers are considered
7 confidential and privileged for all purposes, including for
8 purposes of the Freedom of Information Act, a response to a
9 subpoena, or evidence in a civil action.
10 (g) A copy of an adverse decision against a pharmacy
11 benefit manager for failing to submit an annual report to the
12 Department must be posted to the Department's website.
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