Full Text of HB1462 102nd General Assembly
HB1462ham001 102ND GENERAL ASSEMBLY | Rep. Janet Yang Rohr Filed: 4/4/2022
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| 1 | | AMENDMENT TO HOUSE BILL 1462
| 2 | | AMENDMENT NO. ______. Amend House Bill 1462 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Prescription Drug Affordability Act. | 6 | | Section 5. The General Assembly finds that: | 7 | | (1) Prescription drugs are an essential part of good | 8 | | health care and a critical component of our health care | 9 | | system. Illinoisans spend $13,000,000,000 each year on | 10 | | prescription drugs and have a vested interest in ensuring they | 11 | | are affordable. People living with chronic conditions need | 12 | | prescription drugs to function and stay healthy. Their quality | 13 | | of life is dependent on them. Access to prescription drugs can | 14 | | be the difference between life and death. | 15 | | (2) Illinoisans have faced increasing challenges in | 16 | | affording the prescription drugs they depend upon to be |
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| 1 | | healthy. The costs of brand name drugs have increased 60% | 2 | | since 2014 and annual cost increases regularly outpace medical | 3 | | inflation. | 4 | | (3) Affordability challenges have led more and more | 5 | | Illinoisans to skip doses of prescribed medication and | 6 | | otherwise ration their medication. An estimated 46,000,000 | 7 | | Americans have skipped or rationed their medications due to | 8 | | cost, sometimes leading to serious medical complications. | 9 | | (4) The increase in prescription drug costs is the leading | 10 | | driver of increases in health insurance premiums. High | 11 | | prescription drug costs raise State costs under Medicaid and | 12 | | the State Employee Group Insurance Program, raise employer | 13 | | benefits costs, and are passed onto individuals and families. | 14 | | (5) It is the traditional role of State government to | 15 | | protect the health, safety, and welfare of its residents. | 16 | | Illinois has a long history of ensuring services and products | 17 | | essential to life and health, such as clean water and | 18 | | electricity, are affordable. The State has a compelling reason | 19 | | to ensure prescription drug costs balance consumer access and | 20 | | returns for industry. | 21 | | (6) The current system is causing affordability challenges | 22 | | for those who depend on insulin. The average cost of insulin | 23 | | tripled from 2002 to 2013, and one out of every 4 individuals | 24 | | living with diabetes has had to ration his or her insulin due | 25 | | to cost. This can lead to serious complications including | 26 | | kidney failure, heart disease, blindness, amputations, and |
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| 1 | | death. | 2 | | (7) The current system is causing affordability challenges | 3 | | for those who need prescription drugs to treat multiple | 4 | | sclerosis (MS). Early and ongoing treatment with a | 5 | | disease-modifying therapy for MS is the best way to modify the | 6 | | course of the disease, prevent accumulation of disability, and | 7 | | protect the brain, yet many people cannot access the | 8 | | medications they need. It is estimated that 40% of those | 9 | | living with MS skip doses of medications due to cost. These | 10 | | medications routinely cost $80,000 per year or more and have | 11 | | increased five-fold since they first came to market in the | 12 | | 1990s. | 13 | | (8) The current system is causing affordability challenges | 14 | | for those who need prescription drugs to treat cancer. | 15 | | Prescriptions to treat cancer routinely cost more than | 16 | | $100,000 per year. The incremental increase in cost for a | 17 | | course of treatment increased from $30,447 in 2006 to $161,141 | 18 | | in 2015. Cancer survivors are 2.7 times more likely to file for | 19 | | bankruptcy than those who have not been diagnosed with cancer. | 20 | | (9) The current system is causing affordability challenges | 21 | | for those who need prescription drugs to treat rheumatoid | 22 | | arthritis. Medications to treat rheumatoid arthritis increased | 23 | | 70% in only 3 years. The initial cost of rheumatoid arthritis | 24 | | medication was $10,000 per year when it was first introduced, | 25 | | but has increased to $40,000 per year despite several | 26 | | alternatives coming to market. |
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| 1 | | (10) And yet, some extremist politicians in Washington, | 2 | | D.C., including several representatives of the Illinois | 3 | | delegation, have shamefully blocked efforts to control | 4 | | prescription drug prices, choosing pharmaceutical profits over | 5 | | patient care. | 6 | | (11) The State and its residents are facing numerous | 7 | | affordability challenges across many classes of drugs. The | 8 | | current system has not produced affordable costs. An Illinois | 9 | | Prescription Drug Affordability Board that can review multiple | 10 | | classes of drugs across the supply chain is therefore | 11 | | necessary to determine how best to deliver prescription drug | 12 | | costs that are affordable to all Illinoisans. | 13 | | Section 10. Definitions. In this Act: | 14 | | "Biologic" means a drug that is produced or distributed in | 15 | | accordance with a biologics license application approved under | 16 | | 42 U.S.C. 447.502. | 17 | | "Biosimilar" means a drug that is produced or distributed | 18 | | in accordance with a biologics license application approved | 19 | | under 42 U.S.C. 262(k)(3). | 20 | | "Board" means the Prescription Drug Affordability Board. | 21 | | "Brand name drug" means a drug that is produced or | 22 | | distributed in accordance with an original new drug | 23 | | application approved under 21 U.S.C. 355(c). "Brand name drug" | 24 | | does not include an authorized generic drug as defined by 42 | 25 | | CFR 447.502. |
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| 1 | | "Council" means the Prescription Drug Affordability | 2 | | Stakeholder Council. | 3 | | "Generic drug" means: | 4 | | (1) a retail drug that is marketed or distributed in | 5 | | accordance with an abbreviated new drug application, | 6 | | approved under 21 U.S.C. 355(j); | 7 | | (2) an authorized generic drug as defined by 42 CFR | 8 | | 447.502; or | 9 | | (3) a drug that entered the market before 1962 that | 10 | | was not originally marketed under a new drug application. | 11 | | "Manufacturer" means an entity that: | 12 | | (1) engages in the manufacture of a prescription drug | 13 | | product; or | 14 | | (2) enters into a lease with another manufacturer to | 15 | | market and distribute a prescription drug product under | 16 | | the entity's own name; and | 17 | | (3) sets or changes the wholesale acquisition cost of | 18 | | the prescription drug product it manufactures or markets. | 19 | | "Prescription drug product" means a brand name drug, a | 20 | | generic drug, a biologic, or a biosimilar. | 21 | | Section 15. Prescription Drug Affordability Board. | 22 | | (a) There is established a Prescription Drug Affordability | 23 | | Board. The purpose of the Board is to protect State residents, | 24 | | State and local governments, commercial health plans, health | 25 | | care providers, pharmacies licensed in the State, and other |
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| 1 | | stakeholders within the health care system from the high costs | 2 | | of prescription drug products. The Board is a public body and | 3 | | is an instrumentality of the State. The Board is an | 4 | | independent unit of State government. The exercise by the | 5 | | Board of its authority under this Act is an essential | 6 | | function. | 7 | | (b) The 5 members of the Board and 5 alternates shall be | 8 | | appointed by the Governor with the advice and consent of the | 9 | | Senate. The Governor shall select one member to serve as | 10 | | Chair. If the Senate is not in session when the first | 11 | | appointments are made, the Governor shall make temporary | 12 | | appointments as in the case of a vacancy. No Board seat shall | 13 | | remain vacant more than 60 consecutive days. | 14 | | (c) The Board members and alternates must collectively | 15 | | have expertise in health care economics and clinical medicine. | 16 | | A member or an alternate member may not be an employee of, a | 17 | | board member of, or a consultant to a manufacturer or trade | 18 | | association for manufacturers. | 19 | | (d) Any conflict of interest, including whether the | 20 | | individual has an association, including a financial or | 21 | | personal association, that has the potential to bias or has | 22 | | the appearance of biasing an individual's decision in matters | 23 | | related to the Board or the conduct of the Board's activities, | 24 | | shall be considered and disclosed when appointing members and | 25 | | alternate members to the Board. | 26 | | (e) The term of a member or an alternate member is 5 years. |
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| 1 | | The terms of the members and alternate members shall be | 2 | | staggered. | 3 | | (f) The Chair shall hire an executive director, general | 4 | | counsel, and staff for the Board. Staff of the Board shall | 5 | | receive a salary as provided in the budget of the Board. A | 6 | | member of the Board: (i) may receive compensation as a member | 7 | | of the Board; and (ii) is entitled to reimbursement for | 8 | | expenses. | 9 | | (g) A majority of the members of the Board shall | 10 | | constitute a quorum for the purposes of conducting the | 11 | | business of the Board. | 12 | | (h) Subject to the requirements of this subsection (h), | 13 | | the Board shall meet in open session at least once every 6 | 14 | | weeks to review prescription drug product information. | 15 | | Information concerning the location, date, and time of the | 16 | | meeting must be made publicly available in accordance with the | 17 | | Open Meetings Act. The Chair may cancel or postpone a meeting | 18 | | if there are no prescription drug products to review. | 19 | | The Board shall perform the following actions in open | 20 | | session: (i) deliberations on whether to subject a | 21 | | prescription drug product to a cost review; (ii) any vote on | 22 | | whether to impose an upper payment limit on purchases and | 23 | | payor reimbursements of prescription drug products in the | 24 | | State; and (iii) any decision by the Board. The Board may | 25 | | otherwise meet in closed session to discuss proprietary data | 26 | | and information. |
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| 1 | | The Board shall provide public notice of each Board | 2 | | meeting at least 2 weeks in advance of the meeting. Materials | 3 | | for each Board meeting shall be made available to the public at | 4 | | least one week in advance of the meeting. The Board shall | 5 | | provide an opportunity for public comment at each open meeting | 6 | | of the Board. The Board may not make any binding decisions | 7 | | unless this comment period has been provided with a sufficient | 8 | | amount of time. The Board shall provide the public with the | 9 | | opportunity to provide written comments on pending decisions | 10 | | of the Board. The Board may allow expert testimony at Board | 11 | | meetings, including when the Board meets in closed session. | 12 | | Members of the Board shall recuse themselves from | 13 | | decisions related to a prescription drug product and disclose | 14 | | interests if the member, or an immediate family member of the | 15 | | member, has received or could receive any of the following: | 16 | | (i) a direct financial benefit of any amount deriving from the | 17 | | result or finding of a study or determination by or for the | 18 | | Board; or (ii) a financial benefit from any person that owns, | 19 | | manufactures, or provides prescription drug products, | 20 | | services, or items to be studied by the Board that in the | 21 | | aggregate exceeds $5,000 per year. A disclosure of interests | 22 | | under this paragraph shall include the type, nature, and | 23 | | magnitude of the interests of the member or his or her | 24 | | immediate family member involved. For the purposes of this | 25 | | paragraph, a financial benefit includes honoraria, fees, | 26 | | stock, the value of the member's or immediate family member's |
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| 1 | | stock holdings, and any direct financial benefit deriving from | 2 | | the finding of a review conducted under this Act. | 3 | | A conflict of interest shall be disclosed in advance of | 4 | | the first open meeting after the conflict is identified or | 5 | | within 5 days after the conflict is identified. A conflict of | 6 | | interest shall be disclosed by: (i) the Board when hiring | 7 | | Board staff; (ii) the appointing authority when appointing | 8 | | members and alternate members to the Board and members to the | 9 | | Council; and (iii) the Board when a member of the Board is | 10 | | recused in any final decision resulting from a review of a | 11 | | prescription drug product. A conflict of interest disclosed | 12 | | under this Section shall be posted on the website of the Board | 13 | | unless the Chair of the Board recuses the member from any final | 14 | | decision resulting from a review of a prescription drug | 15 | | product. | 16 | | Members and alternate members of the Board, Board staff, | 17 | | and third-party contractors may not accept any gift or | 18 | | donation of services or property that indicates a potential | 19 | | conflict of interest or has the appearance of biasing the work | 20 | | of the Board. | 21 | | Section 20. Powers and duties of the Board. | 22 | | (a) In furtherance of this Act, the Board shall identify | 23 | | prescription drug products that may create affordability | 24 | | challenges for residents of the State and conduct an | 25 | | affordability review for a minimum of 10 such prescription |
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| 1 | | drug products over the course of a 12-month period. The Board | 2 | | has the authority to set an upper payment limit for such | 3 | | prescription drug products. | 4 | | (b) To the extent practicable, the Board shall access | 5 | | pricing information for prescription drug products by: (i) | 6 | | entering into a memorandum of understanding with another state | 7 | | to which manufacturers already report pricing information; and | 8 | | (ii) accessing other available pricing information. | 9 | | (c) In addition to the powers set forth elsewhere in this | 10 | | Act, the Board may: (i) adopt rules for the implementation of | 11 | | this Act; (ii) enter into a contract with a qualified, | 12 | | independent third party for any service necessary to carry out | 13 | | the powers and duties of the Board; and (iii) exercise any and | 14 | | all other powers necessary or desirable to accomplish the | 15 | | purposes, objectives, and provisions of this Act and to | 16 | | perform its duties under this Act. Unless permission is | 17 | | granted by the Board, a third party hired by the Board may not | 18 | | release, publish, or otherwise use any information to which | 19 | | the third party has access under its contract. | 20 | | Section 25. Prescription Drug Affordability Stakeholder | 21 | | Council. | 22 | | (a) The Prescription Drug Affordability Stakeholder | 23 | | Council is created. | 24 | | (b) The purpose of the Council is to provide stakeholder | 25 | | input to assist the Board in making decisions as required |
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| 1 | | under this Act. | 2 | | (c) The Council shall consist of 25 members appointed 5 | 3 | | each by the Governor, the Speaker of the House of | 4 | | Representatives, the Minority Leader of the House of | 5 | | Representatives, the President of the Senate, and the Minority | 6 | | Leader of the Senate, and shall represent the following | 7 | | entities: | 8 | | (1) two representative of a statewide health care | 9 | | advocacy coalition; | 10 | | (2) one representative of a statewide advocacy | 11 | | organization for seniors; | 12 | | (3) one representative of a statewide organization for | 13 | | diverse communities; | 14 | | (4) two representative of a labor union; | 15 | | (5) two health services researchers specializing in | 16 | | prescription drugs; | 17 | | (6) one representative of doctors; | 18 | | (7) one representative of nurses; | 19 | | (8) one representative of hospitals; | 20 | | (9) one representative of health insurers; | 21 | | (10) one representative of the Governor's Office of | 22 | | Management and Budget; | 23 | | (11) one clinical researcher; | 24 | | (12) one representative of brand name drug | 25 | | corporations; | 26 | | (13) one representative of generic drug corporations; |
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| 1 | | (14) one representative of employers; | 2 | | (15) one representative of pharmacy benefit managers; | 3 | | (16) one representative of pharmacists; | 4 | | (17) one representative of pharmacologists; and | 5 | | (18) five members of the public. | 6 | | (d) The members of the Council shall have knowledge of one | 7 | | or more of the following: | 8 | | (1) the pharmaceutical business model; | 9 | | (2) supply chain business models; | 10 | | (3) the practice of medicine or clinical training; | 11 | | (4) consumer or patient perspectives; | 12 | | (5) health care costs, trends, and drivers; | 13 | | (6) clinical and health services research; or | 14 | | (7) the State's health care marketplace. | 15 | | (e) From among the membership of the Council, the Board | 16 | | chair shall appoint 2 members to be co-chairs of the Council. | 17 | | (f) The term of a member is 3 years. The initial members of | 18 | | the Council shall serve staggered terms. | 19 | | (g) A member of the Council may not receive compensation | 20 | | as a member of the Council, but is entitled to reimbursement | 21 | | for travel expenses. | 22 | | (h) The Board shall ensure Council membership in | 23 | | accordance with this Section and may deny appointment if | 24 | | appointees do not comply. No Council seat shall remain vacant | 25 | | more than 60 consecutive days. |
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| 1 | | Section 30. Drug cost affordability review. | 2 | | (a) The Board shall identify the following prescription | 3 | | drug products and determine whether each identified | 4 | | prescription drug product should be subject to a cost review | 5 | | as described in subsection (e): | 6 | | (1) brand name drugs and biologics that, as adjusted | 7 | | annually for inflation in accordance with the Consumer | 8 | | Price Index, have: | 9 | | (A) a launch wholesale acquisition cost of $30,000 | 10 | | or more for a year or course of treatment; or | 11 | | (B) a wholesale acquisition cost increase of | 12 | | $3,000 or more in any 12-month period, or course of | 13 | | treatment if less than 12 months; | 14 | | (2) biosimilar drugs that have a launch wholesale | 15 | | acquisition cost that is not at least 15% lower than the | 16 | | referenced brand biologic at the time the biosimilar is | 17 | | launched; | 18 | | (3) generic drugs that, as adjusted annually for | 19 | | inflation in accordance with the Consumer Price Index, | 20 | | have a wholesale acquisition cost: | 21 | | (A) of $100 or more for: | 22 | | (i) a 30-day supply lasting a patient for a | 23 | | period 30 consecutive days based on the | 24 | | recommended dosage approved for labeling by the | 25 | | United States Food and Drug Administration; | 26 | | (ii) a supply lasting a patient for fewer than |
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| 1 | | 30 days based on the recommended dosage approved | 2 | | for labeling by the United States Food and Drug | 3 | | Administration; or | 4 | | (iii) one unit of the drug if the labeling | 5 | | approved by the United States Food and Drug | 6 | | Administration does not recommend a finite dosage; | 7 | | and | 8 | | (B) that increased by 200% or more during the | 9 | | preceding 12-month period, as determined by the | 10 | | difference between the resulting wholesale acquisition | 11 | | cost and the average of the wholesale acquisition cost | 12 | | reported over the preceding 12 months; and | 13 | | (4) in consultation with the Council, prescription | 14 | | drug products that may create affordability challenges for | 15 | | the State healthcare system, including patients. | 16 | | (b) After identifying a prescription drug product as | 17 | | required under subsection (a), the Board shall determine | 18 | | whether to conduct a cost review as described in subsection | 19 | | (e) for each identified prescription drug product by: | 20 | | (1) seeking Council input about the prescription drug | 21 | | product; and | 22 | | (2) considering the average patient cost share of the | 23 | | prescription drug product. | 24 | | (c) The information to conduct an affordability review may | 25 | | include any document and research related to the | 26 | | manufacturer's selection of the introductory price or price |
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| 1 | | increase of the prescription drug product, including life | 2 | | cycle management, net average price in the State, market | 3 | | competition and context, projected revenue, and the estimated | 4 | | value or cost–effectiveness of the prescription drug product. | 5 | | (d) A manufacturer shall provide such reports as the Board | 6 | | deems necessary for the Board to conduct an affordability | 7 | | review. The Board shall not unreasonably request information | 8 | | that constitutes proprietary, privileged, or confidential | 9 | | trade secrets under the Freedom of Information Act. Failure of | 10 | | a manufacturer to provide the Board with the information for | 11 | | an affordability review does not affect the authority of the | 12 | | Board to conduct such a review. | 13 | | (e) If the Board conducts a review of the cost and | 14 | | affordability of a prescription drug product, the review shall | 15 | | determine whether use of the prescription drug product that is | 16 | | fully consistent with the labeling approved by the United | 17 | | States Food and Drug Administration or standard medical | 18 | | practice has led or will lead to affordability challenges for | 19 | | the State health care system or high out-of-pocket costs for | 20 | | patients. To the extent practicable, in determining whether a | 21 | | prescription drug product has led or will lead to an | 22 | | affordability challenge, the Board shall consider the | 23 | | following factors: | 24 | | (1) the wholesale acquisition cost for the | 25 | | prescription drug product sold in this State; | 26 | | (2) the average monetary price concession, discount, |
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| 1 | | or rebate the manufacturer provides to health plans in | 2 | | this State or is expected to provide to health plans in | 3 | | this State as reported by manufacturers and health plans, | 4 | | expressed as a percent of the wholesale acquisition cost | 5 | | for the prescription drug product under review; | 6 | | (3) the total amount of the price concession, | 7 | | discount, or rebate the manufacturer provides to each | 8 | | pharmacy benefit manager operating in this State for the | 9 | | prescription drug product under review, as reported by | 10 | | manufacturers and pharmacy benefit managers, expressed as | 11 | | a percent of the wholesale acquisition costs; | 12 | | (4) the price at which therapeutic alternatives have | 13 | | been sold in this State; | 14 | | (5) the average monetary concession, discount, or | 15 | | rebate the manufacturer provides or is expected to provide | 16 | | to health plan payors and pharmacy benefit managers in | 17 | | this State for therapeutic alternatives; | 18 | | (6) the costs to health plans based on patient access | 19 | | consistent with Federal Food and Drug Administration | 20 | | labeled indications and recognized standard medical | 21 | | practice; | 22 | | (7) the impact on patient access resulting from the | 23 | | cost of the prescription drug product relative to | 24 | | insurance benefit design; | 25 | | (8) the current or expected dollar value of | 26 | | drug-specific patient access programs that are supported |
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| 1 | | by the manufacturer; | 2 | | (9) the relative financial impacts to health, medical, | 3 | | or social services costs as can be quantified and compared | 4 | | to baseline effects of existing therapeutic alternatives; | 5 | | (10) the average patient co-pay or other cost-sharing | 6 | | for the prescription drug product in this State; | 7 | | (11) any information a manufacturer chooses to | 8 | | provide; and | 9 | | (12) any other factors as determined by the Board in | 10 | | rules adopted by the Board. | 11 | | (f) If the Board finds that the spending on a prescription | 12 | | drug product reviewed under this Section has led or will lead | 13 | | to an affordability challenge, the Board shall establish an | 14 | | upper payment limit after considering: (i) the cost of | 15 | | administering the drug; (ii) the cost of delivering the drug | 16 | | to consumers; and (iii) other relevant administrative costs | 17 | | related to the drug. The upper payment limit applies to all | 18 | | purchases and payor reimbursements of the prescription drug | 19 | | product dispensed or administered to individuals in the State | 20 | | in person, by mail, or by other means. | 21 | | (g) Any information submitted to the Board in accordance | 22 | | with this Section shall be subject to public inspection only | 23 | | to the extent allowed under the Freedom of Information Act. | 24 | | (h) This Section may not be construed to prevent a | 25 | | manufacturer from marketing a prescription drug product | 26 | | approved by the United States Food and Drug Administration |
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| 1 | | while the product is under review by the Board. | 2 | | Section 35. Remedies. The Attorney General shall have | 3 | | authority to enforce this Act. The Attorney General may pursue | 4 | | any available remedy under State or federal law to accomplish | 5 | | the objectives of this Act. Notwithstanding any other | 6 | | provision of law to the contrary, the Board and its staff shall | 7 | | forward any complaints regarding alleged violations of this | 8 | | Act or any consumer protection law or other law to the Attorney | 9 | | General and work cooperatively with the Attorney General. | 10 | | Nothing in this Section shall be construed to limit the | 11 | | remedies available under State or federal law that provide | 12 | | greater or equal protection to consumers. | 13 | | Section 40. Appeal of Board decisions. | 14 | | (a) A person aggrieved by a decision of the Board may | 15 | | request an appeal of the decision within 30 days after the | 16 | | finding of the Board. | 17 | | (b) The Board shall hear the appeal and make a final | 18 | | decision within 60 days of the hearing. | 19 | | (c) Any person aggrieved by a final decision of the Board | 20 | | may petition for judicial review. | 21 | | Section 45. Prescription Drug Affordability Board Fund. | 22 | | (a) In this Section, "fund" means the Prescription Drug | 23 | | Affordability Board Fund. |
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| 1 | | (b) The Prescription Drug Affordability Board Fund is | 2 | | created. The fund shall be used only to provide funding for the | 3 | | Board and for the purposes authorized under this Act, | 4 | | including any costs expended by any State agency to implement | 5 | | this Act. | 6 | | (c) Any investment earnings shall be retained to the | 7 | | credit of the fund. | 8 | | (d) This Section may not be construed to prohibit the fund | 9 | | from receiving moneys from any other source. | 10 | | (e) The Board shall be established using general funds. | 11 | | Section 50. Report. | 12 | | (a) On or before December 31 of each year, the Board shall | 13 | | submit to the General Assembly a report that includes: | 14 | | (1) price trends for prescription drug products; | 15 | | (2) the number of prescription drug products that were | 16 | | subject to Board review, including the results of the | 17 | | review and the number and disposition of appeals and | 18 | | judicial reviews of Board decisions; and | 19 | | (3) any recommendations the Board may have on further | 20 | | legislation needed to make prescription drug products more | 21 | | affordable in this State. | 22 | | (b) On or before June 1, 2023, the Prescription Drug | 23 | | Affordability Board shall: | 24 | | (1) conduct a study of the operation of the generic | 25 | | drug market in the United States that includes a review of |
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| 1 | | physician-administered drugs and considers: | 2 | | (A) the prices of generic drugs on a | 3 | | year-over-year basis; | 4 | | (B) the degree to which generic drug prices affect | 5 | | yearly insurance premium changes; | 6 | | (C) annual changes in insurance cost-sharing for | 7 | | generic drugs; | 8 | | (D) the potential for and history of drug | 9 | | shortages; | 10 | | (E) the degree to which generic drug prices affect | 11 | | yearly State Medicaid spending; and | 12 | | (F) any other relevant study questions; and | 13 | | (2) report its findings to the General Assembly. | 14 | | Section 55. Term expiration. | 15 | | (a) The terms of the initial members and alternate members | 16 | | of the Prescription Drug Affordability Board shall expire as | 17 | | follows: | 18 | | (1) one member and one alternate member in 2023; | 19 | | (2) two members and 2 alternate members in 2024; and | 20 | | (3) two members, including the Chair of the Board, and | 21 | | 2 alternate members in 2025. | 22 | | (b) The terms of the initial members of the Prescription | 23 | | Drug Affordability Stakeholder Council shall expire as | 24 | | follows: | 25 | | (1) eight members in 2023; |
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| 1 | | (2) eight members in 2024; and | 2 | | (3) nine members in 2025. | 3 | | Section 60. ERISA plans and Medicare drug plans. This Act | 4 | | obligates State-sponsored and State-regulated health plans and | 5 | | health programs to limit drug reimbursements and drug payment | 6 | | to no more than the Board-established upper payment limit. | 7 | | Employee Retirement Income Security Act (ERISA) plans and | 8 | | Medicare Part D plans are not bound by decisions of the Board | 9 | | and can choose to reimburse more than the upper payment limit. | 10 | | Providers who dispense and administer drugs in this State to | 11 | | individuals in this State are bound to bill all payers no more | 12 | | than the upper payment limit to the patient without regard to | 13 | | whether or not an ERISA plan or Medicare Part D plan chooses to | 14 | | reimburse the provider above the upper payment limit. | 15 | | Section 97. Severability. If any provision of this Act or | 16 | | the application thereof to any person or circumstance is held | 17 | | invalid for any reason in a court of competent jurisdiction, | 18 | | the invalidity does not affect other provisions or any other | 19 | | application of this Act that can be given effect without the | 20 | | invalid provision or application, and for this purpose the | 21 | | provisions of this Act are declared severable. | 22 | | Section 900. The State Finance Act is amended by adding | 23 | | Section 5.970 as follows: |
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| 1 | | (30 ILCS 105/5.970 new) | 2 | | Sec. 5.970. The Prescription Drug Affordability Board | 3 | | Fund. | 4 | | Section 999. Effective date. This Act takes effect January | 5 | | 1, 2023.".
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