102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
Introduced 1/27/2022, by Rep. Deanne M. Mazzochi
SYNOPSIS AS INTRODUCED:
Amends the Illinois Insurance Code. In provisions concerning pharmacy
benefit manager contracts, provides that if a retail price is to be used by
a pharmacy benefit manager to calculate or estimate a copayment for a drug,
the pharmacy must either report the retail price for the drug and identify
any programs available to retail customers of the pharmacy that an
individual without prescription drug coverage would be eligible for at the
retail pharmacy that could reduce the price of the drug, or reduce the
retail price reported to account for the price reductions that would be
generally or specifically available to the individual without prescription
drug coverage. Changes the definition of "retail price".
A BILL FOR
|HB4943||LRB102 25487 BMS 34775 b|
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
The Illinois Insurance Code is amended by
changing Section 513b1 as follows:
(215 ILCS 5/513b1)
Pharmacy benefit manager contracts.
(a) As used in this Section:
"Biological product" has the meaning ascribed to that term
in Section 19.5 of the Pharmacy Practice Act.
"Maximum allowable cost" means the maximum amount that a
pharmacy benefit manager will reimburse a pharmacy for the
cost of a drug.
"Maximum allowable cost list" means a list of drugs for
which a maximum allowable cost has been established by a
pharmacy benefit manager.
"Pharmacy benefit manager" means a person, business, or
entity, including a wholly or partially owned or controlled
subsidiary of a pharmacy benefit manager, that provides claims
processing services or other prescription drug or device
services, or both, for health benefit plans.
"Retail price" means the price
an individual without
prescription drug coverage would pay at a retail pharmacy,