Illinois 2025-2026 Regular Session

Illinois House Bill HB1159 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	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
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1159 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED:
3	3	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
4	4	5 ILCS 140/7
5	5	215 ILCS 5/513b1
6	6	215 ILCS 5/513b1.5 new
7	7	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.
8	8	LRB104 06506 BAB 16542 b LRB104 06506 BAB 16542 b
9	9	LRB104 06506 BAB 16542 b
10	10	A BILL FOR
11	11	HB1159LRB104 06506 BAB 16542 b HB1159 LRB104 06506 BAB 16542 b
12	12	HB1159 LRB104 06506 BAB 16542 b
13	13	1 AN ACT concerning regulation.
14	14	2 Be it enacted by the People of the State of Illinois,
15	15	3 represented in the General Assembly:
16	16	4 Section 5. The Freedom of Information Act is amended by
17	17	5 changing Section 7 as follows:
18	18	6 (5 ILCS 140/7)
19	19	7 Sec. 7. Exemptions.
20	20	8 (1) When a request is made to inspect or copy a public
21	21	9 record that contains information that is exempt from
22	22	10 disclosure under this Section, but also contains information
23	23	11 that is not exempt from disclosure, the public body may elect
24	24	12 to redact the information that is exempt. The public body
25	25	13 shall make the remaining information available for inspection
26	26	14 and copying. Subject to this requirement, the following shall
27	27	15 be exempt from inspection and copying:
28	28	16 (a) Information specifically prohibited from
29	29	17 disclosure by federal or State law or rules and
30	30	18 regulations implementing federal or State law.
31	31	19 (b) Private information, unless disclosure is required
32	32	20 by another provision of this Act, a State or federal law,
33	33	21 or a court order.
34	34	22 (b-5) Files, documents, and other data or databases
35	35	23 maintained by one or more law enforcement agencies and
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38	38
39	39	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1159 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED:
40	40	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
41	41	5 ILCS 140/7
42	42	215 ILCS 5/513b1
43	43	215 ILCS 5/513b1.5 new
44	44	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.
45	45	LRB104 06506 BAB 16542 b LRB104 06506 BAB 16542 b
46	46	LRB104 06506 BAB 16542 b
47	47	A BILL FOR
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53	53	5 ILCS 140/7
54	54	215 ILCS 5/513b1
55	55	215 ILCS 5/513b1.5 new
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74	74	1 specifically designed to provide information to one or
75	75	2 more law enforcement agencies regarding the physical or
76	76	3 mental status of one or more individual subjects.
77	77	4 (c) Personal information contained within public
78	78	5 records, the disclosure of which would constitute a
79	79	6 clearly unwarranted invasion of personal privacy, unless
80	80	7 the disclosure is consented to in writing by the
81	81	8 individual subjects of the information. "Unwarranted
82	82	9 invasion of personal privacy" means the disclosure of
83	83	10 information that is highly personal or objectionable to a
84	84	11 reasonable person and in which the subject's right to
85	85	12 privacy outweighs any legitimate public interest in
86	86	13 obtaining the information. The disclosure of information
87	87	14 that bears on the public duties of public employees and
88	88	15 officials shall not be considered an invasion of personal
89	89	16 privacy.
90	90	17 (d) Records in the possession of any public body
91	91	18 created in the course of administrative enforcement
92	92	19 proceedings, and any law enforcement or correctional
93	93	20 agency for law enforcement purposes, but only to the
94	94	21 extent that disclosure would:
95	95	22 (i) interfere with pending or actually and
96	96	23 reasonably contemplated law enforcement proceedings
97	97	24 conducted by any law enforcement or correctional
98	98	25 agency that is the recipient of the request;
99	99	26 (ii) interfere with active administrative
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110	110	1 enforcement proceedings conducted by the public body
111	111	2 that is the recipient of the request;
112	112	3 (iii) create a substantial likelihood that a
113	113	4 person will be deprived of a fair trial or an impartial
114	114	5 hearing;
115	115	6 (iv) unavoidably disclose the identity of a
116	116	7 confidential source, confidential information
117	117	8 furnished only by the confidential source, or persons
118	118	9 who file complaints with or provide information to
119	119	10 administrative, investigative, law enforcement, or
120	120	11 penal agencies; except that the identities of
121	121	12 witnesses to traffic crashes, traffic crash reports,
122	122	13 and rescue reports shall be provided by agencies of
123	123	14 local government, except when disclosure would
124	124	15 interfere with an active criminal investigation
125	125	16 conducted by the agency that is the recipient of the
126	126	17 request;
127	127	18 (v) disclose unique or specialized investigative
128	128	19 techniques other than those generally used and known
129	129	20 or disclose internal documents of correctional
130	130	21 agencies related to detection, observation, or
131	131	22 investigation of incidents of crime or misconduct, and
132	132	23 disclosure would result in demonstrable harm to the
133	133	24 agency or public body that is the recipient of the
134	134	25 request;
135	135	26 (vi) endanger the life or physical safety of law
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146	146	1 enforcement personnel or any other person; or
147	147	2 (vii) obstruct an ongoing criminal investigation
148	148	3 by the agency that is the recipient of the request.
149	149	4 (d-5) A law enforcement record created for law
150	150	5 enforcement purposes and contained in a shared electronic
151	151	6 record management system if the law enforcement agency
152	152	7 that is the recipient of the request did not create the
153	153	8 record, did not participate in or have a role in any of the
154	154	9 events which are the subject of the record, and only has
155	155	10 access to the record through the shared electronic record
156	156	11 management system.
157	157	12 (d-6) Records contained in the Officer Professional
158	158	13 Conduct Database under Section 9.2 of the Illinois Police
159	159	14 Training Act, except to the extent authorized under that
160	160	15 Section. This includes the documents supplied to the
161	161	16 Illinois Law Enforcement Training Standards Board from the
162	162	17 Illinois State Police and Illinois State Police Merit
163	163	18 Board.
164	164	19 (d-7) Information gathered or records created from the
165	165	20 use of automatic license plate readers in connection with
166	166	21 Section 2-130 of the Illinois Vehicle Code.
167	167	22 (e) Records that relate to or affect the security of
168	168	23 correctional institutions and detention facilities.
169	169	24 (e-5) Records requested by persons committed to the
170	170	25 Department of Corrections, Department of Human Services
171	171	26 Division of Mental Health, or a county jail if those
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182	182	1 materials are available in the library of the correctional
183	183	2 institution or facility or jail where the inmate is
184	184	3 confined.
185	185	4 (e-6) Records requested by persons committed to the
186	186	5 Department of Corrections, Department of Human Services
187	187	6 Division of Mental Health, or a county jail if those
188	188	7 materials include records from staff members' personnel
189	189	8 files, staff rosters, or other staffing assignment
190	190	9 information.
191	191	10 (e-7) Records requested by persons committed to the
192	192	11 Department of Corrections or Department of Human Services
193	193	12 Division of Mental Health if those materials are available
194	194	13 through an administrative request to the Department of
195	195	14 Corrections or Department of Human Services Division of
196	196	15 Mental Health.
197	197	16 (e-8) Records requested by a person committed to the
198	198	17 Department of Corrections, Department of Human Services
199	199	18 Division of Mental Health, or a county jail, the
200	200	19 disclosure of which would result in the risk of harm to any
201	201	20 person or the risk of an escape from a jail or correctional
202	202	21 institution or facility.
203	203	22 (e-9) Records requested by a person in a county jail
204	204	23 or committed to the Department of Corrections or
205	205	24 Department of Human Services Division of Mental Health,
206	206	25 containing personal information pertaining to the person's
207	207	26 victim or the victim's family, including, but not limited
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218	218	1 to, a victim's home address, home telephone number, work
219	219	2 or school address, work telephone number, social security
220	220	3 number, or any other identifying information, except as
221	221	4 may be relevant to a requester's current or potential case
222	222	5 or claim.
223	223	6 (e-10) Law enforcement records of other persons
224	224	7 requested by a person committed to the Department of
225	225	8 Corrections, Department of Human Services Division of
226	226	9 Mental Health, or a county jail, including, but not
227	227	10 limited to, arrest and booking records, mug shots, and
228	228	11 crime scene photographs, except as these records may be
229	229	12 relevant to the requester's current or potential case or
230	230	13 claim.
231	231	14 (f) Preliminary drafts, notes, recommendations,
232	232	15 memoranda, and other records in which opinions are
233	233	16 expressed, or policies or actions are formulated, except
234	234	17 that a specific record or relevant portion of a record
235	235	18 shall not be exempt when the record is publicly cited and
236	236	19 identified by the head of the public body. The exemption
237	237	20 provided in this paragraph (f) extends to all those
238	238	21 records of officers and agencies of the General Assembly
239	239	22 that pertain to the preparation of legislative documents.
240	240	23 (g) Trade secrets and commercial or financial
241	241	24 information obtained from a person or business where the
242	242	25 trade secrets or commercial or financial information are
243	243	26 furnished under a claim that they are proprietary,
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254	254	1 privileged, or confidential, and that disclosure of the
255	255	2 trade secrets or commercial or financial information would
256	256	3 cause competitive harm to the person or business, and only
257	257	4 insofar as the claim directly applies to the records
258	258	5 requested.
259	259	6 The information included under this exemption includes
260	260	7 all trade secrets and commercial or financial information
261	261	8 obtained by a public body, including a public pension
262	262	9 fund, from a private equity fund or a privately held
263	263	10 company within the investment portfolio of a private
264	264	11 equity fund as a result of either investing or evaluating
265	265	12 a potential investment of public funds in a private equity
266	266	13 fund. The exemption contained in this item does not apply
267	267	14 to the aggregate financial performance information of a
268	268	15 private equity fund, nor to the identity of the fund's
269	269	16 managers or general partners. The exemption contained in
270	270	17 this item does not apply to the identity of a privately
271	271	18 held company within the investment portfolio of a private
272	272	19 equity fund, unless the disclosure of the identity of a
273	273	20 privately held company may cause competitive harm.
274	274	21 Nothing contained in this paragraph (g) shall be
275	275	22 construed to prevent a person or business from consenting
276	276	23 to disclosure.
277	277	24 (h) Proposals and bids for any contract, grant, or
278	278	25 agreement, including information which if it were
279	279	26 disclosed would frustrate procurement or give an advantage
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290	290	1 to any person proposing to enter into a contractor
291	291	2 agreement with the body, until an award or final selection
292	292	3 is made. Information prepared by or for the body in
293	293	4 preparation of a bid solicitation shall be exempt until an
294	294	5 award or final selection is made.
295	295	6 (i) Valuable formulae, computer geographic systems,
296	296	7 designs, drawings, and research data obtained or produced
297	297	8 by any public body when disclosure could reasonably be
298	298	9 expected to produce private gain or public loss. The
299	299	10 exemption for "computer geographic systems" provided in
300	300	11 this paragraph (i) does not extend to requests made by
301	301	12 news media as defined in Section 2 of this Act when the
302	302	13 requested information is not otherwise exempt and the only
303	303	14 purpose of the request is to access and disseminate
304	304	15 information regarding the health, safety, welfare, or
305	305	16 legal rights of the general public.
306	306	17 (j) The following information pertaining to
307	307	18 educational matters:
308	308	19 (i) test questions, scoring keys, and other
309	309	20 examination data used to administer an academic
310	310	21 examination;
311	311	22 (ii) information received by a primary or
312	312	23 secondary school, college, or university under its
313	313	24 procedures for the evaluation of faculty members by
314	314	25 their academic peers;
315	315	26 (iii) information concerning a school or
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326	326	1 university's adjudication of student disciplinary
327	327	2 cases, but only to the extent that disclosure would
328	328	3 unavoidably reveal the identity of the student; and
329	329	4 (iv) course materials or research materials used
330	330	5 by faculty members.
331	331	6 (k) Architects' plans, engineers' technical
332	332	7 submissions, and other construction related technical
333	333	8 documents for projects not constructed or developed in
334	334	9 whole or in part with public funds and the same for
335	335	10 projects constructed or developed with public funds,
336	336	11 including, but not limited to, power generating and
337	337	12 distribution stations and other transmission and
338	338	13 distribution facilities, water treatment facilities,
339	339	14 airport facilities, sport stadiums, convention centers,
340	340	15 and all government owned, operated, or occupied buildings,
341	341	16 but only to the extent that disclosure would compromise
342	342	17 security.
343	343	18 (l) Minutes of meetings of public bodies closed to the
344	344	19 public as provided in the Open Meetings Act until the
345	345	20 public body makes the minutes available to the public
346	346	21 under Section 2.06 of the Open Meetings Act.
347	347	22 (m) Communications between a public body and an
348	348	23 attorney or auditor representing the public body that
349	349	24 would not be subject to discovery in litigation, and
350	350	25 materials prepared or compiled by or for a public body in
351	351	26 anticipation of a criminal, civil, or administrative
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362	362	1 proceeding upon the request of an attorney advising the
363	363	2 public body, and materials prepared or compiled with
364	364	3 respect to internal audits of public bodies.
365	365	4 (n) Records relating to a public body's adjudication
366	366	5 of employee grievances or disciplinary cases; however,
367	367	6 this exemption shall not extend to the final outcome of
368	368	7 cases in which discipline is imposed.
369	369	8 (o) Administrative or technical information associated
370	370	9 with automated data processing operations, including, but
371	371	10 not limited to, software, operating protocols, computer
372	372	11 program abstracts, file layouts, source listings, object
373	373	12 modules, load modules, user guides, documentation
374	374	13 pertaining to all logical and physical design of
375	375	14 computerized systems, employee manuals, and any other
376	376	15 information that, if disclosed, would jeopardize the
377	377	16 security of the system or its data or the security of
378	378	17 materials exempt under this Section.
379	379	18 (p) Records relating to collective negotiating matters
380	380	19 between public bodies and their employees or
381	381	20 representatives, except that any final contract or
382	382	21 agreement shall be subject to inspection and copying.
383	383	22 (q) Test questions, scoring keys, and other
384	384	23 examination data used to determine the qualifications of
385	385	24 an applicant for a license or employment.
386	386	25 (r) The records, documents, and information relating
387	387	26 to real estate purchase negotiations until those
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398	398	1 negotiations have been completed or otherwise terminated.
399	399	2 With regard to a parcel involved in a pending or actually
400	400	3 and reasonably contemplated eminent domain proceeding
401	401	4 under the Eminent Domain Act, records, documents, and
402	402	5 information relating to that parcel shall be exempt except
403	403	6 as may be allowed under discovery rules adopted by the
404	404	7 Illinois Supreme Court. The records, documents, and
405	405	8 information relating to a real estate sale shall be exempt
406	406	9 until a sale is consummated.
407	407	10 (s) Any and all proprietary information and records
408	408	11 related to the operation of an intergovernmental risk
409	409	12 management association or self-insurance pool or jointly
410	410	13 self-administered health and accident cooperative or pool.
411	411	14 Insurance or self-insurance (including any
412	412	15 intergovernmental risk management association or
413	413	16 self-insurance pool) claims, loss or risk management
414	414	17 information, records, data, advice, or communications.
415	415	18 (t) Information contained in or related to
416	416	19 examination, operating, or condition reports prepared by,
417	417	20 on behalf of, or for the use of a public body responsible
418	418	21 for the regulation or supervision of financial
419	419	22 institutions, insurance companies, or pharmacy benefit
420	420	23 managers, unless disclosure is otherwise required by State
421	421	24 law.
422	422	25 (u) Information that would disclose or might lead to
423	423	26 the disclosure of secret or confidential information,
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434	434	1 codes, algorithms, programs, or private keys intended to
435	435	2 be used to create electronic signatures under the Uniform
436	436	3 Electronic Transactions Act.
437	437	4 (v) Vulnerability assessments, security measures, and
438	438	5 response policies or plans that are designed to identify,
439	439	6 prevent, or respond to potential attacks upon a
440	440	7 community's population or systems, facilities, or
441	441	8 installations, but only to the extent that disclosure
442	442	9 could reasonably be expected to expose the vulnerability
443	443	10 or jeopardize the effectiveness of the measures, policies,
444	444	11 or plans, or the safety of the personnel who implement
445	445	12 them or the public. Information exempt under this item may
446	446	13 include such things as details pertaining to the
447	447	14 mobilization or deployment of personnel or equipment, to
448	448	15 the operation of communication systems or protocols, to
449	449	16 cybersecurity vulnerabilities, or to tactical operations.
450	450	17 (w) (Blank).
451	451	18 (x) Maps and other records regarding the location or
452	452	19 security of generation, transmission, distribution,
453	453	20 storage, gathering, treatment, or switching facilities
454	454	21 owned by a utility, by a power generator, or by the
455	455	22 Illinois Power Agency.
456	456	23 (y) Information contained in or related to proposals,
457	457	24 bids, or negotiations related to electric power
458	458	25 procurement under Section 1-75 of the Illinois Power
459	459	26 Agency Act and Section 16-111.5 of the Public Utilities
460	460
461	461
462	462
463	463
464	464
465	465	HB1159 - 12 - LRB104 06506 BAB 16542 b
466	466
467	467
468	468	HB1159- 13 -LRB104 06506 BAB 16542 b HB1159 - 13 - LRB104 06506 BAB 16542 b
469	469	HB1159 - 13 - LRB104 06506 BAB 16542 b
470	470	1 Act that is determined to be confidential and proprietary
471	471	2 by the Illinois Power Agency or by the Illinois Commerce
472	472	3 Commission.
473	473	4 (z) Information about students exempted from
474	474	5 disclosure under Section 10-20.38 or 34-18.29 of the
475	475	6 School Code, and information about undergraduate students
476	476	7 enrolled at an institution of higher education exempted
477	477	8 from disclosure under Section 25 of the Illinois Credit
478	478	9 Card Marketing Act of 2009.
479	479	10 (aa) Information the disclosure of which is exempted
480	480	11 under the Viatical Settlements Act of 2009.
481	481	12 (bb) Records and information provided to a mortality
482	482	13 review team and records maintained by a mortality review
483	483	14 team appointed under the Department of Juvenile Justice
484	484	15 Mortality Review Team Act.
485	485	16 (cc) Information regarding interments, entombments, or
486	486	17 inurnments of human remains that are submitted to the
487	487	18 Cemetery Oversight Database under the Cemetery Care Act or
488	488	19 the Cemetery Oversight Act, whichever is applicable.
489	489	20 (dd) Correspondence and records (i) that may not be
490	490	21 disclosed under Section 11-9 of the Illinois Public Aid
491	491	22 Code or (ii) that pertain to appeals under Section 11-8 of
492	492	23 the Illinois Public Aid Code.
493	493	24 (ee) The names, addresses, or other personal
494	494	25 information of persons who are minors and are also
495	495	26 participants and registrants in programs of park
496	496
497	497
498	498
499	499
500	500
501	501	HB1159 - 13 - LRB104 06506 BAB 16542 b
502	502
503	503
504	504	HB1159- 14 -LRB104 06506 BAB 16542 b HB1159 - 14 - LRB104 06506 BAB 16542 b
505	505	HB1159 - 14 - LRB104 06506 BAB 16542 b
506	506	1 districts, forest preserve districts, conservation
507	507	2 districts, recreation agencies, and special recreation
508	508	3 associations.
509	509	4 (ff) The names, addresses, or other personal
510	510	5 information of participants and registrants in programs of
511	511	6 park districts, forest preserve districts, conservation
512	512	7 districts, recreation agencies, and special recreation
513	513	8 associations where such programs are targeted primarily to
514	514	9 minors.
515	515	10 (gg) Confidential information described in Section
516	516	11 1-100 of the Illinois Independent Tax Tribunal Act of
517	517	12 2012.
518	518	13 (hh) The report submitted to the State Board of
519	519	14 Education by the School Security and Standards Task Force
520	520	15 under item (8) of subsection (d) of Section 2-3.160 of the
521	521	16 School Code and any information contained in that report.
522	522	17 (ii) Records requested by persons committed to or
523	523	18 detained by the Department of Human Services under the
524	524	19 Sexually Violent Persons Commitment Act or committed to
525	525	20 the Department of Corrections under the Sexually Dangerous
526	526	21 Persons Act if those materials: (i) are available in the
527	527	22 library of the facility where the individual is confined;
528	528	23 (ii) include records from staff members' personnel files,
529	529	24 staff rosters, or other staffing assignment information;
530	530	25 or (iii) are available through an administrative request
531	531	26 to the Department of Human Services or the Department of
532	532
533	533
534	534
535	535
536	536
537	537	HB1159 - 14 - LRB104 06506 BAB 16542 b
538	538
539	539
540	540	HB1159- 15 -LRB104 06506 BAB 16542 b HB1159 - 15 - LRB104 06506 BAB 16542 b
541	541	HB1159 - 15 - LRB104 06506 BAB 16542 b
542	542	1 Corrections.
543	543	2 (jj) Confidential information described in Section
544	544	3 5-535 of the Civil Administrative Code of Illinois.
545	545	4 (kk) The public body's credit card numbers, debit card
546	546	5 numbers, bank account numbers, Federal Employer
547	547	6 Identification Number, security code numbers, passwords,
548	548	7 and similar account information, the disclosure of which
549	549	8 could result in identity theft or impression or defrauding
550	550	9 of a governmental entity or a person.
551	551	10 (ll) Records concerning the work of the threat
552	552	11 assessment team of a school district, including, but not
553	553	12 limited to, any threat assessment procedure under the
554	554	13 School Safety Drill Act and any information contained in
555	555	14 the procedure.
556	556	15 (mm) Information prohibited from being disclosed under
557	557	16 subsections (a) and (b) of Section 15 of the Student
558	558	17 Confidential Reporting Act.
559	559	18 (nn) Proprietary information submitted to the
560	560	19 Environmental Protection Agency under the Drug Take-Back
561	561	20 Act.
562	562	21 (oo) Records described in subsection (f) of Section
563	563	22 3-5-1 of the Unified Code of Corrections.
564	564	23 (pp) Any and all information regarding burials,
565	565	24 interments, or entombments of human remains as required to
566	566	25 be reported to the Department of Natural Resources
567	567	26 pursuant either to the Archaeological and Paleontological
568	568
569	569
570	570
571	571
572	572
573	573	HB1159 - 15 - LRB104 06506 BAB 16542 b
574	574
575	575
576	576	HB1159- 16 -LRB104 06506 BAB 16542 b HB1159 - 16 - LRB104 06506 BAB 16542 b
577	577	HB1159 - 16 - LRB104 06506 BAB 16542 b
578	578	1 Resources Protection Act or the Human Remains Protection
579	579	2 Act.
580	580	3 (qq) Reports described in subsection (e) of Section
581	581	4 16-15 of the Abortion Care Clinical Training Program Act.
582	582	5 (rr) Information obtained by a certified local health
583	583	6 department under the Access to Public Health Data Act.
584	584	7 (ss) For a request directed to a public body that is
585	585	8 also a HIPAA-covered entity, all information that is
586	586	9 protected health information, including demographic
587	587	10 information, that may be contained within or extracted
588	588	11 from any record held by the public body in compliance with
589	589	12 State and federal medical privacy laws and regulations,
590	590	13 including, but not limited to, the Health Insurance
591	591	14 Portability and Accountability Act and its regulations, 45
592	592	15 CFR Parts 160 and 164. As used in this paragraph,
593	593	16 "HIPAA-covered entity" has the meaning given to the term
594	594	17 "covered entity" in 45 CFR 160.103 and "protected health
595	595	18 information" has the meaning given to that term in 45 CFR
596	596	19 160.103.
597	597	20 (tt) Proposals or bids submitted by engineering
598	598	21 consultants in response to requests for proposal or other
599	599	22 competitive bidding requests by the Department of
600	600	23 Transportation or the Illinois Toll Highway Authority.
601	601	24 (uu) Annual reports submitted by pharmacy benefit
602	602	25 managers under Section 513b1.5 of the Illinois Insurance
603	603	26 Code, except for the summary versions of the reports under
604	604
605	605
606	606
607	607
608	608
609	609	HB1159 - 16 - LRB104 06506 BAB 16542 b
610	610
611	611
612	612	HB1159- 17 -LRB104 06506 BAB 16542 b HB1159 - 17 - LRB104 06506 BAB 16542 b
613	613	HB1159 - 17 - LRB104 06506 BAB 16542 b
614	614	1 paragraph (3) of subsection (b) of Section 513b1.5 of the
615	615	2 Illinois Insurance Code.
616	616	3 (1.5) Any information exempt from disclosure under the
617	617	4 Judicial Privacy Act shall be redacted from public records
618	618	5 prior to disclosure under this Act.
619	619	6 (2) A public record that is not in the possession of a
620	620	7 public body but is in the possession of a party with whom the
621	621	8 agency has contracted to perform a governmental function on
622	622	9 behalf of the public body, and that directly relates to the
623	623	10 governmental function and is not otherwise exempt under this
624	624	11 Act, shall be considered a public record of the public body,
625	625	12 for purposes of this Act.
626	626	13 (3) This Section does not authorize withholding of
627	627	14 information or limit the availability of records to the
628	628	15 public, except as stated in this Section or otherwise provided
629	629	16 in this Act.
630	630	17 (Source: P.A. 102-38, eff. 6-25-21; 102-558, eff. 8-20-21;
631	631	18 102-694, eff. 1-7-22; 102-752, eff. 5-6-22; 102-753, eff.
632	632	19 1-1-23; 102-776, eff. 1-1-23; 102-791, eff. 5-13-22; 102-982,
633	633	20 eff. 7-1-23; 102-1055, eff. 6-10-22; 103-154, eff. 6-30-23;
634	634	21 103-423, eff. 1-1-24; 103-446, eff. 8-4-23; 103-462, eff.
635	635	22 8-4-23; 103-540, eff. 1-1-24; 103-554, eff. 1-1-24; 103-605,
636	636	23 eff. 7-1-24; 103-865, eff. 1-1-25.)
637	637	24 Section 10. The Illinois Insurance Code is amended by
638	638	25 changing Section 513b1 and by adding Section 513b1.5 as
639	639
640	640
641	641
642	642
643	643
644	644	HB1159 - 17 - LRB104 06506 BAB 16542 b
645	645
646	646
647	647	HB1159- 18 -LRB104 06506 BAB 16542 b HB1159 - 18 - LRB104 06506 BAB 16542 b
648	648	HB1159 - 18 - LRB104 06506 BAB 16542 b
649	649	1 follows:
650	650	2 (215 ILCS 5/513b1)
651	651	3 Sec. 513b1. Pharmacy benefit manager contracts.
652	652	4 (a) As used in this Section:
653	653	5 "340B drug discount program" means the program established
654	654	6 under Section 340B of the federal Public Health Service Act,
655	655	7 42 U.S.C. 256b.
656	656	8 "340B entity" means a covered entity as defined in 42
657	657	9 U.S.C. 256b(a)(4) authorized to participate in the 340B drug
658	658	10 discount program.
659	659	11 "340B pharmacy" means any pharmacy used to dispense 340B
660	660	12 drugs for a covered entity, whether entity-owned or external.
661	661	13 "Biological product" has the meaning ascribed to that term
662	662	14 in Section 19.5 of the Pharmacy Practice Act.
663	663	15 "Covered individual" means a member, participant,
664	664	16 enrollee, contract holder, policyholder, or beneficiary of a
665	665	17 health benefit plan who is provided a prescription drug
666	666	18 benefit by the health benefit plan.
667	667	19 "Health benefit plan" means a policy, contract,
668	668	20 certificate, or agreement entered into, offered, or issued by
669	669	21 an insurer to provide, deliver, arrange for, pay for, or
670	670	22 reimburse any of the costs of physical, mental, or behavioral
671	671	23 health care services. "Health benefit plan" does not include
672	672	24 Medicaid managed care organizations, as defined in Section
673	673	25 5-30.1 of the Illinois Public Aid Code, or employee welfare
674	674
675	675
676	676
677	677
678	678
679	679	HB1159 - 18 - LRB104 06506 BAB 16542 b
680	680
681	681
682	682	HB1159- 19 -LRB104 06506 BAB 16542 b HB1159 - 19 - LRB104 06506 BAB 16542 b
683	683	HB1159 - 19 - LRB104 06506 BAB 16542 b
684	684	1 benefit plans subject to the federal Employee Retirement
685	685	2 Income Security Act of 1974.
686	686	3 "Maximum allowable cost" means the maximum amount that a
687	687	4 pharmacy benefit manager will reimburse a pharmacy for the
688	688	5 cost of a drug.
689	689	6 "Maximum allowable cost list" means a list of drugs for
690	690	7 which a maximum allowable cost has been established by a
691	691	8 pharmacy benefit manager.
692	692	9 "Pharmacy benefit manager" means a person, business, or
693	693	10 entity, including a wholly or partially owned or controlled
694	694	11 subsidiary of a pharmacy benefit manager, that provides claims
695	695	12 processing services or other prescription drug or device
696	696	13 services, or both, for health benefit plans.
697	697	14 "Rebate aggregator" means a person or entity that
698	698	15 negotiates rebates, discounts, or other fees attributable to
699	699	16 usage by covered individuals with drug manufacturers on behalf
700	700	17 of pharmacy benefit managers or their clients and may also be
701	701	18 involved in contracts that entitle the rebate aggregator or
702	702	19 its client to receive rebates, discounts, or other fees
703	703	20 attributable to usage by covered individuals from drug
704	704	21 manufacturers based on drug utilization or administration.
705	705	22 "Retail price" means the price an individual without
706	706	23 prescription drug coverage would pay at a retail pharmacy, not
707	707	24 including a pharmacist dispensing fee.
708	708	25 "Spread pricing" means the model of prescription drug
709	709	26 pricing in which the pharmacy benefit manager charges a health
710	710
711	711
712	712
713	713
714	714
715	715	HB1159 - 19 - LRB104 06506 BAB 16542 b
716	716
717	717
718	718	HB1159- 20 -LRB104 06506 BAB 16542 b HB1159 - 20 - LRB104 06506 BAB 16542 b
719	719	HB1159 - 20 - LRB104 06506 BAB 16542 b
720	720	1 benefit plan a contracted price for prescription drugs and the
721	721	2 contracted price for the prescription drugs differs from the
722	722	3 amount the pharmacy benefit manager directly or indirectly
723	723	4 pays the pharmacist or pharmacy for pharmacist services.
724	724	5 "Steer" includes, but is not limited to:
725	725	6 (1) requiring a covered individual to use only a
726	726	7 pharmacy, including a mail-order pharmacy, in which the
727	727	8 pharmacy benefit manager maintains an ownership interest
728	728	9 or control;
729	729	10 (2) offering or implementing a plan design that
730	730	11 encourages a covered individual to use a pharmacy in which
731	731	12 the pharmacy benefit manager maintains an ownership
732	732	13 interest or control, if such plan design increases costs
733	733	14 for the covered individual, including requiring a covered
734	734	15 individual to pay full costs for a prescription if the
735	735	16 covered individual chooses not to use a pharmacy owned or
736	736	17 controlled by the pharmacy benefit manager;
737	737	18 (3) reimbursing a pharmacy or pharmacist for a
738	738	19 pharmaceutical product or pharmacist service in an amount
739	739	20 less than the amount that the pharmacy benefit manager
740	740	21 reimburses itself or an affiliate for providing the same
741	741	22 product or services, unless the pharmacy or pharmacist
742	742	23 contractually agrees to a lower reimbursement amount; or
743	743	24 (4) any other actions determined by the Department by
744	744	25 rule.
745	745	26 "Third-party payer" means any entity that pays for
746	746
747	747
748	748
749	749
750	750
751	751	HB1159 - 20 - LRB104 06506 BAB 16542 b
752	752
753	753
754	754	HB1159- 21 -LRB104 06506 BAB 16542 b HB1159 - 21 - LRB104 06506 BAB 16542 b
755	755	HB1159 - 21 - LRB104 06506 BAB 16542 b
756	756	1 prescription drugs on behalf of a patient other than a health
757	757	2 care provider or sponsor of a plan subject to regulation under
758	758	3 Medicare Part D, 42 U.S.C. 1395w-101 et seq.
759	759	4 (b) A contract between a health insurer and a pharmacy
760	760	5 benefit manager must require that the pharmacy benefit
761	761	6 manager:
762	762	7 (1) Update maximum allowable cost pricing information
763	763	8 at least every 7 calendar days.
764	764	9 (2) Maintain a process that will, in a timely manner,
765	765	10 eliminate drugs from maximum allowable cost lists or
766	766	11 modify drug prices to remain consistent with changes in
767	767	12 pricing data used in formulating maximum allowable cost
768	768	13 prices and product availability.
769	769	14 (3) Provide access to its maximum allowable cost list
770	770	15 to each pharmacy or pharmacy services administrative
771	771	16 organization subject to the maximum allowable cost list.
772	772	17 Access may include a real-time pharmacy website portal to
773	773	18 be able to view the maximum allowable cost list. As used in
774	774	19 this Section, "pharmacy services administrative
775	775	20 organization" means an entity operating within the State
776	776	21 that contracts with independent pharmacies to conduct
777	777	22 business on their behalf with third-party payers. A
778	778	23 pharmacy services administrative organization may provide
779	779	24 administrative services to pharmacies and negotiate and
780	780	25 enter into contracts with third-party payers or pharmacy
781	781	26 benefit managers on behalf of pharmacies.
782	782
783	783
784	784
785	785
786	786
787	787	HB1159 - 21 - LRB104 06506 BAB 16542 b
788	788
789	789
790	790	HB1159- 22 -LRB104 06506 BAB 16542 b HB1159 - 22 - LRB104 06506 BAB 16542 b
791	791	HB1159 - 22 - LRB104 06506 BAB 16542 b
792	792	1 (4) Provide a process by which a contracted pharmacy
793	793	2 can appeal the provider's reimbursement for a drug subject
794	794	3 to maximum allowable cost pricing. The appeals process
795	795	4 must, at a minimum, include the following:
796	796	5 (A) A requirement that a contracted pharmacy has
797	797	6 14 calendar days after the applicable fill date to
798	798	7 appeal a maximum allowable cost if the reimbursement
799	799	8 for the drug is less than the net amount that the
800	800	9 network provider paid to the supplier of the drug.
801	801	10 (B) A requirement that a pharmacy benefit manager
802	802	11 must respond to a challenge within 14 calendar days of
803	803	12 the contracted pharmacy making the claim for which the
804	804	13 appeal has been submitted.
805	805	14 (C) A telephone number and e-mail address or
806	806	15 website to network providers, at which the provider
807	807	16 can contact the pharmacy benefit manager to process
808	808	17 and submit an appeal.
809	809	18 (D) A requirement that, if an appeal is denied,
810	810	19 the pharmacy benefit manager must provide the reason
811	811	20 for the denial and the name and the national drug code
812	812	21 number from national or regional wholesalers.
813	813	22 (E) A requirement that, if an appeal is sustained,
814	814	23 the pharmacy benefit manager must make an adjustment
815	815	24 in the drug price effective the date the challenge is
816	816	25 resolved and make the adjustment applicable to all
817	817	26 similarly situated network pharmacy providers, as
818	818
819	819
820	820
821	821
822	822
823	823	HB1159 - 22 - LRB104 06506 BAB 16542 b
824	824
825	825
826	826	HB1159- 23 -LRB104 06506 BAB 16542 b HB1159 - 23 - LRB104 06506 BAB 16542 b
827	827	HB1159 - 23 - LRB104 06506 BAB 16542 b
828	828	1 determined by the managed care organization or
829	829	2 pharmacy benefit manager.
830	830	3 (5) Allow a plan sponsor whose coverage is
831	831	4 administered by the contracting with a pharmacy benefit
832	832	5 manager an annual right to audit compliance with the terms
833	833	6 of the contract by the pharmacy benefit manager,
834	834	7 including, but not limited to, full disclosure of any and
835	835	8 all rebate amounts secured, whether product specific or
836	836	9 generalized rebates, that were provided to the pharmacy
837	837	10 benefit manager by a pharmaceutical manufacturer.
838	838	11 (6) Allow a plan sponsor whose coverage is
839	839	12 administered by the contracting with a pharmacy benefit
840	840	13 manager to request that the pharmacy benefit manager
841	841	14 disclose the actual amounts paid by the pharmacy benefit
842	842	15 manager to the pharmacy.
843	843	16 (7) Provide notice to the plan sponsor and the party
844	844	17 contracting with the pharmacy benefit manager of any
845	845	18 consideration that the pharmacy benefit manager receives
846	846	19 from the manufacturer for dispense as written
847	847	20 prescriptions once a generic or biologically similar
848	848	21 product becomes available.
849	849	22 (c) In order to place a particular prescription drug on a
850	850	23 maximum allowable cost list, the pharmacy benefit manager
851	851	24 must, at a minimum, ensure that:
852	852	25 (1) if the drug is a generically equivalent drug, it
853	853	26 is listed as therapeutically equivalent and
854	854
855	855
856	856
857	857
858	858
859	859	HB1159 - 23 - LRB104 06506 BAB 16542 b
860	860
861	861
862	862	HB1159- 24 -LRB104 06506 BAB 16542 b HB1159 - 24 - LRB104 06506 BAB 16542 b
863	863	HB1159 - 24 - LRB104 06506 BAB 16542 b
864	864	1 pharmaceutically equivalent "A" or "B" rated in the United
865	865	2 States Food and Drug Administration's most recent version
866	866	3 of the "Orange Book" or have an NR or NA rating by
867	867	4 Medi-Span, Gold Standard, or a similar rating by a
868	868	5 nationally recognized reference;
869	869	6 (2) the drug is available for purchase by each
870	870	7 pharmacy in the State from national or regional
871	871	8 wholesalers operating in Illinois; and
872	872	9 (3) the drug is not obsolete.
873	873	10 (d) A pharmacy benefit manager is prohibited from limiting
874	874	11 a pharmacist's ability to disclose whether the cost-sharing
875	875	12 obligation exceeds the retail price for a covered prescription
876	876	13 drug, and the availability of a more affordable alternative
877	877	14 drug, if one is available in accordance with Section 42 of the
878	878	15 Pharmacy Practice Act.
879	879	16 (e) A health benefit plan insurer or pharmacy benefit
880	880	17 manager shall not require a covered individual an insured to
881	881	18 make a payment for a prescription drug at the point of sale in
882	882	19 an amount that exceeds the lesser of:
883	883	20 (1) the applicable cost-sharing amount; or
884	884	21 (2) the retail price of the drug in the absence of
885	885	22 prescription drug coverage.
886	886	23 (f) Unless required by law, a contract between a pharmacy
887	887	24 benefit manager or third-party payer and a 340B entity or 340B
888	888	25 pharmacy shall not contain any provision that:
889	889	26 (1) distinguishes between drugs purchased through the
890	890
891	891
892	892
893	893
894	894
895	895	HB1159 - 24 - LRB104 06506 BAB 16542 b
896	896
897	897
898	898	HB1159- 25 -LRB104 06506 BAB 16542 b HB1159 - 25 - LRB104 06506 BAB 16542 b
899	899	HB1159 - 25 - LRB104 06506 BAB 16542 b
900	900	1 340B drug discount program and other drugs when
901	901	2 determining reimbursement or reimbursement methodologies,
902	902	3 or contains otherwise less favorable payment terms or
903	903	4 reimbursement methodologies for 340B entities or 340B
904	904	5 pharmacies when compared to similarly situated non-340B
905	905	6 entities;
906	906	7 (2) imposes any fee, chargeback, or rate adjustment
907	907	8 that is not similarly imposed on similarly situated
908	908	9 pharmacies that are not 340B entities or 340B pharmacies;
909	909	10 (3) imposes any fee, chargeback, or rate adjustment
910	910	11 that exceeds the fee, chargeback, or rate adjustment that
911	911	12 is not similarly imposed on similarly situated pharmacies
912	912	13 that are not 340B entities or 340B pharmacies;
913	913	14 (4) prevents or interferes with an individual's choice
914	914	15 to receive a covered prescription drug from a 340B entity
915	915	16 or 340B pharmacy through any legally permissible means,
916	916	17 except that nothing in this paragraph shall prohibit the
917	917	18 establishment of differing copayments or other
918	918	19 cost-sharing amounts within the health benefit plan for
919	919	20 covered individuals persons who acquire covered
920	920	21 prescription drugs from a nonpreferred or nonparticipating
921	921	22 provider;
922	922	23 (5) excludes a 340B entity or 340B pharmacy from a
923	923	24 pharmacy network on any basis that includes consideration
924	924	25 of whether the 340B entity or 340B pharmacy participates
925	925	26 in the 340B drug discount program;
926	926
927	927
928	928
929	929
930	930
931	931	HB1159 - 25 - LRB104 06506 BAB 16542 b
932	932
933	933
934	934	HB1159- 26 -LRB104 06506 BAB 16542 b HB1159 - 26 - LRB104 06506 BAB 16542 b
935	935	HB1159 - 26 - LRB104 06506 BAB 16542 b
936	936	1 (6) prevents a 340B entity or 340B pharmacy from using
937	937	2 a drug purchased under the 340B drug discount program; or
938	938	3 (7) any other provision that discriminates against a
939	939	4 340B entity or 340B pharmacy by treating the 340B entity
940	940	5 or 340B pharmacy differently than non-340B entities or
941	941	6 non-340B pharmacies for any reason relating to the
942	942	7 entity's participation in the 340B drug discount program.
943	943	8 As used in this subsection, "pharmacy benefit manager" and
944	944	9 "third-party payer" do not include pharmacy benefit managers
945	945	10 and third-party payers acting on behalf of a Medicaid program
946	946	11 or an employee welfare benefit plan subject to the federal
947	947	12 Employee Retirement Income Security Act of 1974.
948	948	13 (f-5) A pharmacy benefit manager or an affiliate acting on
949	949	14 the pharmacy benefit manager's behalf is prohibited from
950	950	15 conducting spread pricing in this State.
951	951	16 (f-10) A pharmacy benefit manager or an affiliate acting
952	952	17 on the pharmacy benefit manager's behalf shall not steer a
953	953	18 covered individual.
954	954	19 (f-15) A pharmacy benefit manager or an affiliate acting
955	955	20 on the pharmacy benefit manager's behalf must remit 100% of
956	956	21 rebates and fees to the health benefit plan sponsor, consumer,
957	957	22 or employer. Records of rebates and fees remitted from the
958	958	23 pharmacy benefit manager or its contracted party shall be
959	959	24 retained for 7 years.
960	960	25 (f-20) A pharmacy benefit manager may not reimburse a
961	961	26 pharmacy or pharmacist for a prescription drug or pharmacy
962	962
963	963
964	964
965	965
966	966
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968	968
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972	972	1 service in an amount less than the national average drug
973	973	2 acquisition cost for the prescription drug or pharmacy service
974	974	3 at the time the drug is administered or dispensed, plus a
975	975	4 professional dispensing fee of $10.49. However, if the
976	976	5 national average drug acquisition cost is not available at the
977	977	6 time a drug is administered or dispensed, a pharmacy benefit
978	978	7 manager may not reimburse in an amount that is less than the
979	979	8 wholesale acquisition cost of the drug, as defined in 42
980	980	9 U.S.C. 1395w-3a(c)(6)(B), plus a professional dispensing fee
981	981	10 of $10.49.
982	982	11 (f-25) A pharmacy benefit manager or an affiliate acting
983	983	12 on the pharmacy benefit manager's behalf is prohibited from
984	984	13 limiting a covered individual's access to prescription drugs
985	985	14 from a pharmacy or pharmacist enrolled with the health benefit
986	986	15 plan under the terms offered to all pharmacies in the plan
987	987	16 coverage area by unreasonably designating the covered
988	988	17 prescription drugs as a specialty drug.
989	989	18 (f-30) The contract between the pharmacy benefit manager
990	990	19 and the insurer or health benefit plan sponsor must allow and
991	991	20 provide for the pharmacy benefit manager's compliance with an
992	992	21 audit at least once per calendar year of the rebate and fee
993	993	22 records remitted from a pharmacy benefit manager or its
994	994	23 contracted party to a health benefit plan. Contracts with
995	995	24 rebate aggregators or drug manufactures must be available for
996	996	25 audit by health benefit plan sponsors or designated third
997	997	26 parties at least once per plan year. Audits shall be performed
998	998
999	999
1000	1000
1001	1001
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1004	1004
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1008	1008	1 by an auditor selected by the health benefit plan sponsor.
1009	1009	2 Rebate contracts with rebate aggregators or drug manufactures
1010	1010	3 shall be available for audit by health benefit plan sponsors.
1011	1011	4 (g) A violation of this Section by a pharmacy benefit
1012	1012	5 manager constitutes an unfair or deceptive act or practice in
1013	1013	6 the business of insurance under Section 424.
1014	1014	7 (h) A provision that violates subsection (f) in a
1015	1015	8 contract between a pharmacy benefit manager or a third-party
1016	1016	9 payer and a 340B entity that is entered into, amended, or
1017	1017	10 renewed after July 1, 2022 shall be void and unenforceable.
1018	1018	11 (i)(1) A pharmacy benefit manager may not retaliate
1019	1019	12 against a pharmacist or pharmacy for disclosing information in
1020	1020	13 a court, in an administrative hearing, before a legislative
1021	1021	14 commission or committee, or in any other proceeding, if the
1022	1022	15 pharmacist or pharmacy has reasonable cause to believe that
1023	1023	16 the disclosed information is evidence of a violation of a
1024	1024	17 State or federal law, rule, or regulation.
1025	1025	18 (2) A pharmacy benefit manager may not retaliate against a
1026	1026	19 pharmacist or pharmacy for disclosing information to a
1027	1027	20 government or law enforcement agency, if the pharmacist or
1028	1028	21 pharmacy has reasonable cause to believe that the disclosed
1029	1029	22 information is evidence of a violation of a State or federal
1030	1030	23 law, rule, or regulation.
1031	1031	24 (3) A pharmacist or pharmacy shall make commercially
1032	1032	25 reasonable efforts to limit the disclosure of confidential and
1033	1033	26 proprietary information.
1034	1034
1035	1035
1036	1036
1037	1037
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1044	1044	1 (4) Retaliatory actions against a pharmacy or pharmacist
1045	1045	2 include cancellation of, restriction of, or refusal to renew
1046	1046	3 or offer a contract to a pharmacy solely because the pharmacy
1047	1047	4 or pharmacist has:
1048	1048	5 (A) made disclosures of information that the
1049	1049	6 pharmacist or pharmacy has reasonable cause to believe is
1050	1050	7 evidence of a violation of a State or federal law, rule, or
1051	1051	8 regulation;
1052	1052	9 (B) filed complaints with the plan or pharmacy benefit
1053	1053	10 manager; or
1054	1054	11 (C) filed complaints against the plan or pharmacy
1055	1055	12 benefit manager with the Department.
1056	1056	13 (j) This Section applies to contracts entered into or
1057	1057	14 renewed on or after July 1, 2022.
1058	1058	15 (k) This Section applies to any health benefit group or
1059	1059	16 individual policy of accident and health insurance or managed
1060	1060	17 care plan that provides coverage for prescription drugs and
1061	1061	18 that is amended, delivered, issued, or renewed on or after
1062	1062	19 July 1, 2020.
1063	1063	20 (Source: P.A. 102-778, eff. 7-1-22; 103-154, eff. 6-30-23;
1064	1064	21 103-453, eff. 8-4-23.)
1065	1065	22 (215 ILCS 5/513b1.5 new)
1066	1066	23 Sec. 513b1.5. Pharmacy benefit manager reporting
1067	1067	24 requirements.
1068	1068	25 (a) A pharmacy benefit manager that provides services for
1069	1069
1070	1070
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1079	1079	1 a health benefit plan must submit an annual report, by no later
1080	1080	2 than September 1, to the health benefit plan sponsor and
1081	1081	3 issuer and include the following:
1082	1082	4 (1) information collected from drug manufacturers on
1083	1083	5 copayment assistance;
1084	1084	6 (2) a list of drugs covered by the health benefit
1085	1085	7 plan, including details such as the brand name, generic
1086	1086	8 name, number of participants, number of prescription
1087	1087	9 claims, dosage units, dispensing channel used, wholesale
1088	1088	10 acquisition cost, net cost, and total out-of-pocket
1089	1089	11 spending by covered individual;
1090	1090	12 (3) information on each therapeutic class of drugs;
1091	1091	13 (4) the amount received by the health benefit plan in
1092	1092	14 rebates, fees, or discounts related to drug utilization or
1093	1093	15 spending;
1094	1094	16 (5) total gross spending on prescription drugs;
1095	1095	17 (6) total net spending on prescription drugs by the
1096	1096	18 health benefit plan;
1097	1097	19 (7) any compensation paid to brokers, consultants,
1098	1098	20 advisors, or any other individual or firm for referrals,
1099	1099	21 consideration, or retention by the health benefit plan;
1100	1100	22 and
1101	1101	23 (8) an explanation of benefit design parameters
1102	1102	24 encouraging or requiring covered individuals to use
1103	1103	25 affiliated pharmacies, the percentage of prescriptions
1104	1104	26 charged by these pharmacies, and a list of drugs dispensed
1105	1105
1106	1106
1107	1107
1108	1108
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1111	1111
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1115	1115	1 by affiliated pharmacies with their associated costs.
1116	1116	2 (b) Annual reports submitted pursuant to subsection (a):
1117	1117	3 (1) must be written in plain language to ensure ease
1118	1118	4 of reading and accessibility;
1119	1119	5 (2) may only contain summary health information to
1120	1120	6 ensure plan, coverage, or covered individual information
1121	1121	7 remains private and confidential;
1122	1122	8 (3) upon request by a covered individual, must be
1123	1123	9 available in summary format and provide aggregated
1124	1124	10 information to help covered individuals understand their
1125	1125	11 health benefit plan's prescription drug coverage; and
1126	1126	12 (4) must be filed with the Department no later than
1127	1127	13 September 1 of each year via the System for Electronic
1128	1128	14 Rates & Forms Filing. The filing shall include the summary
1129	1129	15 version of the report described in paragraph (3) of this
1130	1130	16 subsection, which shall be marked for public access.
1131	1131	17 (c) A pharmacy benefit manager may petition the Department
1132	1132	18 for a filing submission extension. The Director may grant or
1133	1133	19 deny the extension within 5 business days after receiving the
1134	1134	20 petition.
1135	1135	21 (d) Failure by a pharmacy benefit manager to submit an
1136	1136	22 annual report to the Department may result in a fine levied by
1137	1137	23 the Director not to exceed $1,000 per day. Funds derived from
1138	1138	24 fines levied shall be deposited into the Insurance Producer
1139	1139	25 Administration Fund. Fine information shall be posted on the
1140	1140	26 Department's website.
1141	1141
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1151	1151	1 (e) A pharmacy benefit manager found in violation of
1152	1152	2 subsection (a) or paragraph (4) of subsection (b) may request
1153	1153	3 a hearing from the Director within 10 days after being found in
1154	1154	4 violation.
1155	1155	5 (f) Except for the summary versions, the annual reports
1156	1156	6 submitted by pharmacy benefit managers are considered
1157	1157	7 confidential and privileged for all purposes, including for
1158	1158	8 purposes of the Freedom of Information Act, a response to a
1159	1159	9 subpoena, or evidence in a civil action.
1160	1160	10 (g) A copy of an adverse decision against a pharmacy
1161	1161	11 benefit manager for failing to submit an annual report to the
1162	1162	12 Department must be posted to the Department's website.
1163	1163
1164	1164
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