HB3187 101ST GENERAL ASSEMBLY

LRB101 10860 RAB 56000 b

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.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by adding Article XXXIIB as follows:

(215 ILCS 5/Art. XXXIIB heading new)

ARTICLE XXXIIB. PHARMACY BENEFIT MANAGERS

(215 ILCS 5/521.1 new)

Sec. 521.1. Pharmacy benefit managers.

(a) As used in this Section, "pharmacy benefit manager" means a person, business, or other entity that, pursuant to a contract or under an employment relationship with a plan sponsor, insurer, or other third-party payer, either directly or through an intermediary, manages the prescription drug coverage provided by the plan sponsor, insurer, or third-party payer, including, but not limited to, the processing and payment claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to prescription drug coverage, contracting with network pharmacies, and controlling the cost of covered prescription drugs.

"Biological product" has the same meaning given to that term in Section 19.5 of the Pharmacy Practice Act.

(b) Upon request by a party contracting with a pharmacy benefit manager, the party has an annual right to audit compliance with the terms of the contract by the pharmacy benefit manager, including, but not limited to, full disclosure of any and all rebate amounts secured, whether product specific or generalized rebates, that were provided to the pharmacy benefit manager by a pharmaceutical manufacturer.

(c) 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.

(d) 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.

(e) Any provision of a contract entered into, amended, or renewed on or after the effective date of this amendatory Act of the 101st General Assembly that is contrary to this Section is unenforceable.