Bill Status of SB 2790   103rd General Assembly

Short Description:  DHFS-MCO-PBM-CONTRACTS

Senate Sponsors
Sen. David Koehler, Patrick J. Joyce-Laura M. Murphy, Cristina Castro, Steve McClure, Sally J. Turner, Doris Turner, Dale Fowler and Rachel Ventura

Last Action  View All Actions

DateChamber Action
  1/7/2025SenateSession Sine Die

Statutes Amended In Order of Appearance
305 ILCS 5/5-36a new

Synopsis As Introduced
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall not enter into a contract with a managed care organization that relies on a pharmacy benefit manager that does not do the following: (i) utilize a pharmacy reimbursement methodology of the lesser of national average drug acquisition cost plus a professional dispensing fee as determined by the Department, the wholesale acquisition cost plus a professional dispensing fee as determined by the Department, or the usual and customary charge by the pharmacy; (ii) reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; (iii) agree to move to a transparent pass-through pricing model, in which the pharmacy benefit manager discloses the administrative fee as a percentage of the professional dispensing costs to the Department; (iv) agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and (v) agree to not terminate an existing contract with a pharmacy licensed under the Pharmacy Practice Act for the sole reason of the additional professional dispensing fee authorized under item (i). Requires each pharmacy benefit manager that receives reimbursement for medical services, either directly or through a Medicaid managed care health plan, to submit by January 15, 2026, and each January 15 thereafter, certain data and information to the Department for the previous fiscal year, including: (1) the total number of prescriptions that were dispensed; (2) the aggregate wholesale acquisition cost for each drug on its formulary; (3) the aggregate amount of rebates, discounts, and price concessions that the pharmacy benefit manager received for each drug on its formulary; (4) the aggregate amount of administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers; and (5) any other information considered necessary by the Department. Requires the Department to submit such data and information to the General Assembly and to the Governor's Office of Management and Budget. Provides that such information is confidential and not subject to disclosure under the Freedom of Information Act.

Actions 
DateChamber Action
  1/17/2024SenateFiled with Secretary by Sen. Laura M. Murphy
  1/17/2024SenateFirst Reading
  1/17/2024SenateReferred to Assignments
  2/7/2024SenateChief Sponsor Changed to Sen. David Koehler
  3/5/2024SenateAdded as Co-Sponsor Sen. Patrick J. Joyce
  3/7/2024SenateAdded as Chief Co-Sponsor Sen. Laura M. Murphy
  3/7/2024SenateAdded as Co-Sponsor Sen. Cristina Castro
  3/13/2024SenateAdded as Co-Sponsor Sen. Steve McClure
  3/25/2024SenateAdded as Co-Sponsor Sen. Sally J. Turner
  4/30/2024SenateAdded as Co-Sponsor Sen. Doris Turner
  5/2/2024SenateAdded as Co-Sponsor Sen. Dale Fowler
  11/20/2024SenateAdded as Co-Sponsor Sen. Rachel Ventura
  1/7/2025SenateSession Sine Die

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