101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3187

 

Introduced , by Rep. Deanne M. Mazzochi

 

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

    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.


LRB101 10860 RAB 56000 b

 

 

A BILL FOR

 

HB3187LRB101 10860 RAB 56000 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 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"
11means a person, business, or other entity that, pursuant to a
12contract or under an employment relationship with a plan
13sponsor, insurer, or other third-party payer, either directly
14or through an intermediary, manages the prescription drug
15coverage provided by the plan sponsor, insurer, or third-party
16payer, including, but not limited to, the processing and
17payment claims for prescription drugs, the performance of drug
18utilization review, the processing of drug prior authorization
19requests, the adjudication of appeals or grievances related to
20prescription drug coverage, contracting with network
21pharmacies, and controlling the cost of covered prescription
22drugs.

 

 

HB3187- 2 -LRB101 10860 RAB 56000 b

1    "Biological product" has the same meaning given to that
2term in Section 19.5 of the Pharmacy Practice Act.
3    (b) Upon request by a party contracting with a pharmacy
4benefit manager, the party has an annual right to audit
5compliance with the terms of the contract by the pharmacy
6benefit manager, including, but not limited to, full disclosure
7of any and all rebate amounts secured, whether product specific
8or generalized rebates, that were provided to the pharmacy
9benefit manager by a pharmaceutical manufacturer.
10    (c) Upon request by a party contracting with a pharmacy
11benefit manager, a pharmacy benefit manager shall disclose the
12actual amounts paid by the pharmacy benefit manager to the
13pharmacy.
14    (d) A pharmacy benefit manager shall provide notice to the
15party contracting with the pharmacy benefit manager of any
16consideration that the pharmacy benefit manager receives from
17the manufacturer for dispense as written prescriptions once a
18generic or biologically similar product becomes available.
19    (e) Any provision of a contract entered into, amended, or
20renewed on or after the effective date of this amendatory Act
21of the 101st General Assembly that is contrary to this Section
22is unenforceable.