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.