Bill Text: IL HB3187 | 2019-2020 | 101st General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. Creates the Pharmacy Benefit Managers Article. Provides that upon request by a party contracting with a pharmacy benefit manager, a pharmacy benefit manager shall disclose any rebate amounts provided to the pharmacy benefit manager by a pharmaceutical manufacturer. Provides that upon request by a party contracting with a pharmacy benefit manager, a pharmacy benefit manager shall disclose the actual amounts paid by the pharmacy benefit manager to the pharmacy. Provides that a pharmacy benefit manager shall provide notice to the party contracting with the pharmacy benefit manager of any consideration that the pharmacy benefit manager receives from the manufacturer for dispense as written prescriptions once a generic or biologically similar product becomes available. Provides that any provision of a contract entered into, amended, or renewed on or after the effective date of the amendatory Act that is contrary is unenforceable.
Spectrum: Slight Partisan Bill (Republican 8-3)
Status: (Introduced - Dead) 2019-04-12 - Rule 19(a) / Re-referred to Rules Committee [HB3187 Detail]
Download: Illinois-2019-HB3187-Introduced.html
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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by adding | |||||||||||||||||||||
5 | Article XXXIIB as follows:
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6 | (215 ILCS 5/Art. XXXIIB heading new) | |||||||||||||||||||||
7 | ARTICLE XXXIIB. PHARMACY BENEFIT MANAGERS | |||||||||||||||||||||
8 | (215 ILCS 5/521.1 new) | |||||||||||||||||||||
9 | Sec. 521.1. Pharmacy benefit managers. | |||||||||||||||||||||
10 | (a) As used in this Section, "pharmacy benefit manager" | |||||||||||||||||||||
11 | means a person, business, or other entity that, pursuant to a | |||||||||||||||||||||
12 | contract or under an employment relationship with a plan | |||||||||||||||||||||
13 | sponsor, insurer, or other third-party payer, either directly | |||||||||||||||||||||
14 | or through an intermediary, manages the prescription drug | |||||||||||||||||||||
15 | coverage provided by the plan sponsor, insurer, or third-party | |||||||||||||||||||||
16 | payer, including, but not limited to, the processing and | |||||||||||||||||||||
17 | payment claims for prescription drugs, the performance of drug | |||||||||||||||||||||
18 | utilization review, the processing of drug prior authorization | |||||||||||||||||||||
19 | requests, the adjudication of appeals or grievances related to | |||||||||||||||||||||
20 | prescription drug coverage, contracting with network | |||||||||||||||||||||
21 | pharmacies, and controlling the cost of covered prescription | |||||||||||||||||||||
22 | drugs. |
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1 | "Biological product" has the same meaning given to that | ||||||
2 | term in Section 19.5 of the Pharmacy Practice Act. | ||||||
3 | (b) Upon request by a party contracting with a pharmacy | ||||||
4 | benefit manager, the party has an annual right to audit | ||||||
5 | compliance with the terms of the contract by the pharmacy | ||||||
6 | benefit manager, including, but not limited to, full disclosure | ||||||
7 | of any and all rebate amounts secured, whether product specific | ||||||
8 | or generalized rebates, that were provided to the pharmacy | ||||||
9 | benefit manager by a pharmaceutical manufacturer. | ||||||
10 | (c) Upon request by a party contracting with a pharmacy | ||||||
11 | benefit manager, a pharmacy benefit manager shall disclose the | ||||||
12 | actual amounts paid by the pharmacy benefit manager to the | ||||||
13 | pharmacy. | ||||||
14 | (d) A pharmacy benefit manager shall provide notice to the | ||||||
15 | party contracting with the pharmacy benefit manager of any | ||||||
16 | consideration that the pharmacy benefit manager receives from | ||||||
17 | the manufacturer for dispense as written prescriptions once a | ||||||
18 | generic or biologically similar product becomes available. | ||||||
19 | (e) Any provision of a contract entered into, amended, or | ||||||
20 | renewed on or after the effective date of this amendatory Act | ||||||
21 | of the 101st General Assembly that is contrary to this Section | ||||||
22 | is unenforceable.
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