101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB0891

 

Introduced , by Rep. Joe Sosnowski

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/Art. XXXIIB heading new
215 ILCS 5/521.1 new
215 ILCS 5/521.5 new

    Amends the Illinois Insurance Code. Creates the Pharmacy Benefits Managers Article. Provides that a pharmacy or pharmacist shall have the right to provide an insured information regarding the amount of the insured's cost share for a prescription drug and that neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing certain information or for selling a lower-priced drug to the insured if one is available. Provides that a pharmacy benefits manager shall not, through contract, prohibit a pharmacy from offering and providing direct and limited delivery services to an insured as an ancillary service of the pharmacy, as delineated in the contract between the pharmacy benefits manager and the pharmacy. Provides that a pharmacy benefits manager shall not charge, or attempt to collect from, an insured a copayment that exceeds the total charges submitted by the network pharmacy.


LRB101 05148 SMS 50160 b

 

 

A BILL FOR

 

HB0891LRB101 05148 SMS 50160 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by adding
5Article XXXIIB as follows:
 
6    (215 ILCS 5/Art. XXXIIB heading new)
7
ARTICLE XXXIIB. PHARMACY BENEFITS MANAGERS

 
8    (215 ILCS 5/521.1 new)
9    Sec. 521.1. Definitions. As used in this Article:
10    "Health benefit plan" means any accident and health
11insurance policy or certificate; nonprofit hospital or medical
12service corporation contract; health, hospital, or medical
13service corporation plan contract; health maintenance
14organization subscriber contract; plan provided by a multiple
15employer welfare arrangement or plan provided by another
16benefit arrangement, to the extent permitted by the federal
17Employee Retirement Income Security Act of 1974.
18    "Insured" means an individual covered by a health benefit
19plan.
20    "Insurer" means any entity that provides or offers a health
21benefit plan.
22    "Pharmacist" has the same meaning given to that term in the

 

 

HB0891- 2 -LRB101 05148 SMS 50160 b

1Pharmacy Practice Act.
2    "Pharmacy" has the same meaning given to that term in the
3Pharmacy Practice Act.
4    "Pharmacy benefits manager" means an entity that contracts
5with a pharmacy on behalf of an insurer or third-party
6administrator to administer or manage prescription drug
7benefits.
 
8    (215 ILCS 5/521.5 new)
9    Sec. 521.5. Consumer protections.
10    (a) A pharmacy or pharmacist shall have the right to
11provide an insured information regarding the amount of the
12insured's cost share for a prescription drug. Neither a
13pharmacy nor a pharmacist shall be penalized by a pharmacy
14benefits manager for discussing any information described in
15this Section or for selling a lower-priced drug to the insured
16if one is available.
17    (b) A pharmacy benefits manager shall not, through
18contract, prohibit a pharmacy from offering and providing
19direct and limited delivery services to an insured as an
20ancillary service of the pharmacy, as delineated in the
21contract between the pharmacy benefits manager and the
22pharmacy.
23    (c) A pharmacy benefits manager shall not charge, or
24attempt to collect from, an insured a copayment that exceeds
25the total charges submitted by the network pharmacy.