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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 SB1828
Introduced 2/25/2005, by Sen. Dale A. Righter SYNOPSIS AS INTRODUCED: |
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New Act |
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30 ILCS 105/5.640 new |
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30 ILCS 105/8g |
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Creates the Pharmacy Benefit Manager Licensure and Solvency Protection Act to establish standards and criteria for the regulation, solvency, and licensing of pharmacy benefit managers. Requires pharmacy benefits managers to obtain a certificate of authority from the Department of Financial and Professional Regulation and a certificate of compliance from the State Board of Pharmacy. Sets forth provisions concerning disclosures, records, financial examination, an annual statement and filing fee, contracts and agreements, prohibited acts and practices, medication reimbursement costs, timely payments and audits, authorization for substitutions, and complaint and claim processes. Grants rulemaking authority to the Department and the Board. Amends the State Finance Act to create the Pharmacy Benefits Management Fund and to provide that no transfers may be made to the General Revenue Fund from the Pharmacy Benefits Management Fund. Effective immediately.
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| FISCAL NOTE ACT MAY APPLY | |
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A BILL FOR
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the |
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| Pharmacy Benefit Manager Licensure and Solvency Protection |
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| Act. |
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| Section 5. Purpose; intent. The purpose of this Act is to |
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| establish standards and criteria for the regulation, solvency, |
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| and licensing of pharmacy benefit managers. This Act is |
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| designed to promote, preserve, and protect the public health, |
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| safety, and welfare by and through effective regulation, |
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| solvency requirements, and licensing of pharmacy benefit |
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| managers. |
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| Section 10. Definitions. In this Act: |
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| "Board" means the State Board of Pharmacy of the Department |
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| of Financial and Professional Regulation. |
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| "Covered entity" means a non-profit hospital or medical |
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| service corporation, health insurer, health benefit plan, or |
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| health maintenance organization; a health program administered |
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| by a department or the State in the capacity of provider of |
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| health coverage; or an employer, labor union, or other group of |
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| persons organized in the State that provides health coverage to |
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| covered individuals who are employed or reside in the State. |
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| "Covered entity" does not include a self-funded plan that is |
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| exempt from State regulation pursuant to the federal Employee |
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| Retirement Income Security Act (ERISA), a plan issued for |
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| coverage for federal employees, or a health plan that provides |
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| coverage only for accidental injury, specified disease, |
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| hospital indemnity, medicare supplement, disability income, |
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| long-term care, or other limited benefit health insurance |
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| policies and contracts. |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| "Covered person" means a member, policyholder, subscriber, |
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| enrollee, beneficiary,
dependent, or other individual |
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| participating in a health benefit plan. |
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| "Department" means the Department of Financial and |
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| Professional Regulation. |
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| "Health benefit plan" means a policy, contract, |
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| certificate, or agreement offered or
issued by a health carrier |
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| to provide, deliver, arrange for, pay for, or reimburse any of |
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| the
costs of health care services including prescription drug |
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| benefits. |
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| "Maintenance drug" means a drug prescribed by a |
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| practitioner who is authorized to
prescribe drugs and used to |
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| treat a medical condition for a period greater than 30
days. |
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| "Multi-source drug" means a drug that is stocked and is |
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| available from 3 or
more suppliers. |
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| "Pharmacist" means any individual properly licensed as a |
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| pharmacist by the Board. |
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| "Pharmacist services" includes drug therapy and other |
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| patient care services
provided by a licensed pharmacist |
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| intended to achieve outcomes related to the
cure or prevention |
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| of a disease, elimination or reduction of a patient's symptoms,
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| or arresting or slowing of a disease process as defined in |
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| rules adopted by the Board. |
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| "Pharmacy" has the meaning given to that term in the |
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| Pharmacy Practice Act of 1987. |
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| "Pharmacy benefits management" means (i) the procurement |
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| of prescription drugs at a
negotiated rate for dispensation |
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| within this State to covered persons, (ii) the administration |
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| or management of prescription drug benefits provided by a |
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| covered entity for the benefit of covered persons, or (iii) any |
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| of the following services provided with regard to the |
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| administration of pharmacy benefits: |
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| (1) Mail service pharmacy. |
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| (2) Claims processing, retail network management, and |
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| payment of claims to pharmacies for prescription drugs |
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| dispensed to covered persons. |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| (3) Clinical formulary development and management |
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| services. |
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| (4) Rebate contracting and administration. |
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| (5) Certain patient compliance, therapeutic |
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| intervention, and generic substitution programs. |
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| (6) Disease management programs involving prescription |
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| drug utilization. |
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| "Pharmacy benefits manager" or "PBM" means a person, |
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| business, or other entity that
performs pharmacy benefits |
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| management. "Pharmacy benefits manager" or "PBM" includes a |
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| person or entity acting for a PBM in a contractual or |
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| employment relationship in the performance of pharmacy |
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| benefits management for a covered entity and includes mail |
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| service pharmacies. |
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| "Practice of pharmacy" has the meaning given to the term in |
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| the Pharmacy Practice Act of 1987. |
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| "Secretary" means the Secretary of Financial and |
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| Professional Regulation. |
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| "Usual and customary price" means the price the pharmacist |
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| would have charged
a cash paying patient, not a patient where |
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| reimbursement rates are set by a contract, for the same |
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| services on the same date inclusive of any discounts |
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| applicable. |
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| Section 15. Applicability and scope. This Act shall apply |
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| to a PBM that provides claims processing services, other |
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| prescription drug or device services, or both, to covered |
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| persons who are residents of this State. |
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| Section 20. Certificate of authority to act as a PBM. |
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| (a) No person or organization shall act or operate as a PBM |
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| in this State without a valid certificate of authority issued |
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| by the Department. The failure of any person to hold a |
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| certificate while acting as a PBM shall subject that person to |
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| a fine of not less than $5,000 and not more than $10,000 for |
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| each violation. |
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LRB094 11306 RAS 42120 b |
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| (b) Each person seeking a certificate of authority to act |
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| as a PBM shall file with the Department an application for a |
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| certificate of authority upon a form to be furnished by the |
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| Department. This application shall include or be accompanied by |
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| all of the following: |
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| (1) All basic organizational documents of the PBM, such |
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| as the articles of incorporation, articles of association, |
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| bylaws, partnership agreement, trade name certificate, |
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| trust agreement, shareholder agreement, and other |
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| applicable documents and all amendments to these |
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| documents. |
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| (2) The names, addresses, official positions, and |
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| professional qualifications of the individuals who are |
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| responsible for the conduct of the affairs of the PBM, |
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| including all members of the board of directors, board of |
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| trustees, executive committee, other governing board, or |
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| committee, the principal officers in the case of a |
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| corporation, the partners or members in the case of a |
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| partnership or association, and any other person who |
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| exercises control or influence over the affairs of the PBM. |
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| (3) A certificate of compliance issued by the Board |
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| indicating that the PBM's plan of operation is consistent |
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| with the Pharmacy Practice Act of 1987 and any rules |
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| adopted under that Act. |
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| (4) Annual statements or reports for the 3 most recent |
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| years, or such other information as the Department may |
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| require in order to review the current financial condition |
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| of the applicant.
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| (5) If the applicant is not currently acting as a PBM, |
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| a statement of the amounts and sources of funds available |
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| for organization expenses and the proposed arrangements |
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| for reimbursement and compensation of incorporators or |
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| other principals. |
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| (6) The name and address of the agent for service of |
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| process in the State. |
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| (7) A detailed description of the claims processing |
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LRB094 11306 RAS 42120 b |
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| services, pharmacy services, insurance services, other |
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| prescription drug or device services, audit procedures for |
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| network pharmacies, or other administrative services to be |
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| provided. |
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| (8) All incentive arrangements or programs, such as |
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| rebates, discounts, disbursements, or any other similar |
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| financial program or arrangement relating to income or |
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| consideration received or negotiated, directly or |
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| indirectly, with any pharmaceutical company, that relates |
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| to prescription drug or device services, including, at a |
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| minimum, information on the formula or other method for |
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| calculation and amount of the incentive arrangements, |
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| rebates or other disbursements, the identity of the |
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| associated drug or device, and the dates and amounts of the |
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| disbursements. |
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| (9) A filing fee of $5,000. |
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| (10) Any other information the Secretary may require. |
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| (c) The applicant shall make available for inspection by |
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| the Department copies of all contracts with insurers, |
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| pharmaceutical manufacturers, or other persons utilizing the |
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| services of the PBM for pharmacy benefit management services. |
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| Certain contracts are subject to prior approval as provided in |
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| Section 45. |
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| (d) The Department shall not issue a certificate of |
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| authority if it determines that the PBM or any principal of the |
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| PBM is not competent, trustworthy, financially responsible, or |
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| of good personal and business reputation or has had an |
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| insurance license or pharmacy license denied for cause by any |
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| state.
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| (e) A PBM shall maintain a fidelity bond equal to at least |
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| 10% of the amount of the funds handled or managed annually by |
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| the PBM. However, the Department may require an amount in |
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| excess of $500,000, but not more than 10% of the amount of the |
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| funds handled or managed annually by the PBM. A copy shall be |
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| provided to the Department.
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| (f) Any person or entity that fits the definition of a |
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LRB094 11306 RAS 42120 b |
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| "PBM" on the effective date of this amendatory Act of the 94th |
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| General Assembly shall have 90 days in which to obtain a |
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| certificate of authority from the Department in order to |
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| continue to validly operate in this State. |
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| Section 25. Certificate of compliance issued by Board.
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| (a) Each PBM seeking to become licensed in the State must |
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| submit its plan of operation for review in a format prescribed |
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| by the Board. |
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| (b) The Board will review the submission in order to |
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| determine if it complies with the Pharmacy Practice Act of |
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| 1987. The Board shall adopt rules, including, but not limited |
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| to, rules concerning the format required, the filing fee, the |
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| requirements for re-certification, and any other information |
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| the Board may require to complete its review. The fees |
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| collected shall be used solely for the purpose of regulating |
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| PBMs. |
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| (c) If the PBM's filing meets with Board approval, it shall |
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| be issued a certificate of compliance. Subsequent material |
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| changes in the plan of operation must be filed with the Board.
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| Section 30. Disclosure of ownership or affiliation and |
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| certain agreements.
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| (a) Each PBM shall disclose to the Department any ownership |
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| interest or affiliation of any kind with (i) any insurance |
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| company responsible for providing benefits directly or through |
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| reinsurance to any plan for which the PBM provides services or |
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| (ii) any parent companies, subsidiaries, and other entities or |
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| businesses relative to the provision of pharmacy services, |
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| other prescription drug or device services, or a pharmaceutical |
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| manufacturer. |
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| (b) The PBM must notify the Department in writing within 5 |
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| calendar days of any material change in its ownership. |
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| (c) Every PBM shall disclose all of the following |
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| agreements:
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| (1) Any agreement with a pharmaceutical manufacturer |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| to favor that manufacturer's products over a competitor's |
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| products or to place that manufacturer's drug on the PBM's |
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| preferred list or formulary or to switch the drug |
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| prescribed by the patient's health care provider with a |
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| drug agreed to by the PBM and that manufacturer. |
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| (2) Any agreement with a pharmaceutical manufacturer |
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| to share manufacturer rebates and discounts with the PBM or |
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| to pay money or other economic benefits to the PBM. |
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| (3) Any agreement to bill, or practice of billing, the |
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| health plan for prescription drugs at a cost higher than |
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| the PBM pays the pharmacy. |
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| (4) Any agreement to share revenue with a mail order or |
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| internet pharmacy company. |
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| (5) Any agreement to sell prescription drug data, |
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| including data concerning the prescribing practices of the |
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| health care providers in the State.
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| Section 35. Maintenance, access, and confidentiality of |
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| records; financial examination. |
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| (a) Every PBM shall maintain, for the duration of the |
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| written agreement and for 2 years
thereafter, books and records |
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| of all transactions between the PBM, insurers, covered persons,
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| pharmacists, and pharmacies. |
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| (b) The Department shall have access to books and records |
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| maintained by the PBM for the purposes of examination, audit, |
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| and inspection. All information contained in these books and |
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| records shall be confidential. However, the Department may use |
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| the information in any proceeding instituted against the PBM or |
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| insurer. |
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| (c) The Secretary shall conduct periodic financial |
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| examinations of every PBM in this State
to ensure an |
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| appropriate level of regulatory oversight. The PBM shall pay |
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| the cost of the
examination which shall be deposited in a |
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| special fund to provide all expenses for the
regulation, |
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| supervision, and examination of all entities subject to |
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| regulation under this Act.
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LRB094 11306 RAS 42120 b |
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| Section 40. Annual statement and filing fee required.
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| (a) Each authorized PBM shall file with the Department an |
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| annual statement on or before March 1 of every year. The |
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| statement shall be in a form and contain those matters |
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| prescribed by the Department and shall be accompanied by the |
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| filing fee established by the Department. It must include the |
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| total number of persons subject to management by the PBM during |
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| the year, the number of persons terminated during the year, the |
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| number of persons covered at the end of the year, and the |
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| dollar value of claims processed. |
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| (b) The statement shall disclose all incentive |
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| arrangements or programs, such as rebates, discounts, |
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| disbursements, or any other similar financial program or |
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| arrangement relating to income or consideration received or |
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| negotiated, directly or indirectly, with any pharmaceutical |
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| company, that relates to prescription drug or device services, |
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| including, at a minimum, information on the formula or other |
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| method for calculation and amount of the incentive |
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| arrangements, rebates, or other disbursements, the identity of |
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| the associated drug or device, and the dates and amounts of the |
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| disbursements. |
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| Section 45. Contracts; agreement approval; prohibited |
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| provisions. |
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| (a) No person may act on behalf of a PBM without a written |
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| agreement between the person and the PBM. |
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| (b) A PBM shall not require a pharmacist or pharmacy to |
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| participate in one contract in order to participate in another |
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| contract. The PBM shall not exclude an otherwise qualified |
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| pharmacist or pharmacy from participation in a particular |
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| network solely because that pharmacist or pharmacy declined to |
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| participate in another plan or network managed by the PBM. |
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| (c) The PBM must file with the Department a copy of all |
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| contracts or agreements with pharmacies for approval not less |
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| than 30 days before the execution of the contract or agreement. |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| The Department shall consult with the Board on the criteria |
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| prior to promulgation. The contract shall be deemed approved |
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| unless the Department disapproves it within 30 days after it is |
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| filed.
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| (d) The written agreement between the insurer and the PBM |
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| shall not provide that the
pharmacist or pharmacy is |
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| responsible for the actions of the insurer or the PBM. |
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| (e) All agreements shall provide that when the PBM receives |
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| payment for the services
of the pharmacist or pharmacy that the |
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| PBM shall act as a fiduciary of the pharmacy or pharmacist who |
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| provided the services. The PBM shall distribute said funds in |
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| accordance with the time frames set forth in this Act.
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| Section 50. PBM prohibited practices.
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| (a) A PBM shall not intervene in the delivery or |
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| transmission of prescriptions from the
prescriber to the |
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| pharmacist or pharmacy for the purpose of (i) influencing the |
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| prescriber's choice of therapy, (ii) influencing the patient's |
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| choice of pharmacist or pharmacy, or (iii) altering the |
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| prescription information, including but not limited to, |
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| switching the prescribed drug without the express |
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| authorization of the prescriber. |
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| (b) No agreement shall mandate that a pharmacist or |
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| pharmacy change a covered person's prescription, unless the |
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| prescribing physician and the covered person authorize the |
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| pharmacist to make the change. |
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| (c) The insurer and the PBM may not discriminate with |
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| respect to participation in the network or reimbursement as to |
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| any pharmacist or pharmacy that is acting within the scope of |
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| his or her license or certification. |
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| (d) The PBM may not transfer a health benefit plan to |
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| another payment network unless it receives written |
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| authorization from the insurer. |
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| (e) No PBM may discriminate when contracting with |
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| pharmacies on the basis of co-payments or days of supply. A |
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| contract shall apply the same coinsurance, co-payment, and |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| deductible to covered drug prescriptions filled by any |
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| pharmacy, including a mail order pharmacy or pharmacist who |
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| participates in the network. |
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| (f) No PBM may discriminate when advertising which |
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| pharmacies are participating pharmacies. Any list of |
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| participating pharmacies shall be complete and all inclusive. |
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| (g) No PBM may mandate basic record keeping by any |
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| pharmacist or pharmacy that is more stringent than required by |
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| State or federal laws or regulations. |
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| Section 55. Termination of agreements.
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| (a) A pharmacist or pharmacy may not be terminated from the |
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| network or penalized by a PBM solely because of filing a |
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| complaint, grievance, or appeal as permitted under this Act. |
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| (b) A pharmacist or pharmacy may not be terminated from the |
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| network or penalized because it expresses disagreement with the |
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| PBM's decision to deny or limit benefits to a covered person or |
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| because the pharmacist or pharmacy assists a covered person in |
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| seeking reconsideration of the PBM's decision or because the |
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| pharmacist or pharmacy discusses alternative medications. |
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| (c) Before terminating a pharmacy from the network, the PBM |
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| must give the
pharmacy or pharmacist a written explanation of |
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| the reason for the termination at least 30 days prior to the |
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| termination date, unless the termination is based on (i) the |
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| loss of the pharmacy's license to practice pharmacy or |
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| cancellation of professional liability insurance or (ii) a |
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| conviction of fraud. |
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| (d) Termination of a contract between a PBM and a pharmacy |
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| or pharmacist, or termination of a pharmacy or pharmacist from |
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| a PBM's provider network shall not release the PBM from the |
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| obligation to make any payment due to the pharmacy or |
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| pharmacist for pharmacist services rendered.
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| Section 60. Medication reimbursement costs; use of index |
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| required. PBMs shall use a current and nationally recognized |
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| benchmark to base the reimbursement paid to network pharmacies |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| for medications and products. This reimbursement must be |
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| determined as follows: |
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| (1) For brand or single source products, the Average |
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| Wholesale Price (AWP) as listed in First Data Bank (Hearst |
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| publications) or Facts & Comparisons (formerly Medispan) |
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| correct and current on the date of service provided shall |
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| be used as an index. |
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| (2) For generic drug or multi-source products, Maximum |
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| Allowable Cost (MAC) shall be established by referencing |
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| First Data Bank (Hearst publications) or Facts & |
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| Comparisons (formerly Medispan) Baseline Price (BLP). Only |
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| products that are compliant with pharmacy laws as |
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| equivalent and generically interchangeable with a federal |
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| FDA Orange Book rating of "A-B" will be reimbursed from a |
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| MAC price methodology. If a multi-source product has no BLP |
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| price, then it shall be treated as a single source branded |
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| drug for the purpose of determining reimbursement.
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| Section 65. Timely payments; audits. |
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| (a) If a PBM processes claims via electronic review, then |
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| it shall electronically transmit
payment within 7 calendar days |
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| of said claims transmission to the pharmacist or pharmacy. |
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| Specific time limits for the PBM to pay the pharmacist for all |
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| other services rendered must be set forth in the agreement. |
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| (b) Within 24 hours of a price increase notification by a |
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| manufacturer or supplier, the PBM must adjust its payments to |
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| the pharmacist or pharmacy consistent with the price increase. |
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| (c) Claims paid by the PBM shall not be retroactively |
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| denied or adjusted after 7 days from adjudication of such |
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| claims, except as provided in subsection (d) of this Section. |
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| In no case shall acknowledgement of eligibility be |
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| retroactively reversed. |
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| (d) The PBM may retroactively deny or adjust in the event |
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| of any of the following: |
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| (1) The original claim was submitted fraudulently. |
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| (2) The original claim payment was incorrect because |
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SB1828 |
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LRB094 11306 RAS 42120 b |
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| the provider was already paid for services rendered. |
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| (3) The services were not rendered by the pharmacist or |
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| pharmacy. |
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| (e) The PBM may not require extrapolation audits as a |
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| condition of participating in the contract, network, or |
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| program. |
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| (f) The PBM shall not recoup any moneys that it believes |
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| are due as a result of the audit by setoff until the pharmacist |
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| or pharmacy has the opportunity to review the PBM's findings |
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| and concurs with the results. If the parties cannot agree, then |
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| the audit shall be subject to review by the Board. |
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| Section 70. Disclosures to covered persons; authorization |
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| for substitutions.
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| (a) When the services of a PBM are utilized, the PBM must |
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| provide a written notice
approved by the insurer to covered |
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| persons advising them of the identity of, and relationship |
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| between, the PBM, the insured, and the covered person. |
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| (b) The notice must contain a statement advising the |
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| covered person that the PBM is
regulated by the Department and |
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| has the right to file a complaint, appeal, or grievance with |
21 |
| the Department concerning the PBM. The notice shall include the |
22 |
| toll-free telephone number, mailing address, and electronic |
23 |
| mail address of the Department. |
24 |
| (c) The notice must be written in plain English, using |
25 |
| terms that may be generally
understood by the prudent |
26 |
| layperson, and a copy must be provided to the Department and |
27 |
| each pharmacist or pharmacy participating in the network. |
28 |
| (d) If a PBM requests a substitute prescription for a |
29 |
| prescribed drug to a covered person, then the following |
30 |
| provisions shall apply: |
31 |
| (1) The PBM may substitute a lower-priced generic and |
32 |
| therapeutically equivalent drug for a higher-priced |
33 |
| prescribed drug. |
34 |
| (2) With regard to substitutions in which the |
35 |
| substitute drug costs more than the prescribed drug, the |
|
|
|
SB1828 |
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LRB094 11306 RAS 42120 b |
|
|
1 |
| substitution must be made for medical reasons that benefit |
2 |
| the covered individual. If a substitution is being made |
3 |
| under this subparagraph, the PBM shall obtain the approval |
4 |
| of the prescribing health professional or that person's |
5 |
| authorized representative after disclosing to the covered |
6 |
| individual the cost of both drugs and any benefit or |
7 |
| payment directly or indirectly accruing to the PBM as a |
8 |
| result of the substitution and any potential effects on a |
9 |
| patient's health and safety, including side effects.
|
10 |
| (3) The PBM shall transfer, in full, to the covered |
11 |
| entity any benefit or payment received in any form by the |
12 |
| PBM as a result of a prescription drug substitution under |
13 |
| paragraph (1) or (2) of this subsection (d).
|
14 |
| Section 75. Complaint process.
|
15 |
| (a) The Department and the Board shall each adopt |
16 |
| procedures for formal investigation of complaints concerning |
17 |
| the failure of a pharmacy benefits manager to comply with this |
18 |
| Act. |
19 |
| (b) The Department shall refer a complaint filed under this |
20 |
| Act to the Board if the complaint involves a professional or |
21 |
| patient health or safety issue. |
22 |
| (c) The Board shall refer a complaint filed under this Act |
23 |
| to the Department if the complaint involves a business or |
24 |
| financial issue.
|
25 |
| Section 80. Adjustment or settlement of claims; |
26 |
| compensation of PBM. Compensation to a PBM for any claims that |
27 |
| the PBM adjusts or settles on behalf of an insurer shall in no |
28 |
| way be contingent on claims experience. This Section does not |
29 |
| prohibit the compensation of a PBM based on total number of |
30 |
| claims paid or processed. |
31 |
| Section 85. PBM responsibilities to the covered entity.
|
32 |
| (a) A PBM shall provide to a covered entity all financial |
33 |
| and utilization information requested by the covered entity |
|
|
|
SB1828 |
- 14 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| relating to the provision of benefits to covered individuals |
2 |
| through that covered entity and all financial and utilization |
3 |
| information relating to services to that covered entity. A PBM |
4 |
| providing information under this Section may designate that |
5 |
| material as confidential. Information designated as |
6 |
| confidential by a PBM and provided to a covered entity under |
7 |
| this Section may not be disclosed by the covered entity to any |
8 |
| person without the consent to the PBM, except that disclosure |
9 |
| may be made when authorized by a court. |
10 |
| (b) A PBM shall disclose to the covered entity all |
11 |
| financial terms and arrangements for remuneration of any kind |
12 |
| that apply between the PBM and any prescription drug |
13 |
| manufacturer or labeler, including, without limitation, |
14 |
| rebates, formulary management and drug-switch or substitution |
15 |
| programs, educational support, claims processing, and pharmacy |
16 |
| network fees that are charged from retail pharmacies and data |
17 |
| sales fees. |
18 |
| (c) A PBM shall disclose to the covered entity whether |
19 |
| there is a difference between the price paid to retail pharmacy |
20 |
| and the amount billed to the covered entity for the purchase. |
21 |
| (d) The covered entity may audit the PBM's books and |
22 |
| records related to the rebates or other information provided in |
23 |
| subsections (a) through (c) of this Section. |
24 |
| (e) A PBM shall perform its duties exercising good faith |
25 |
| and fair dealing toward the covered entity. |
26 |
| Section 90. Pharmacy Benefits Management Fund. The |
27 |
| Pharmacy Benefits Management Fund is created as a special fund |
28 |
| in the State Treasury. All
fees, fines, assessments, and |
29 |
| penalties received
under this Act shall be deposited into the |
30 |
| Pharmacy Benefits Management Fund.
|
31 |
| Section 95. Assessment; Secretary. |
32 |
| (a) The expense of administering this Act, including the |
33 |
| costs incurred by the Secretary, shall be assessed annually by |
34 |
| the Secretary against all PBMs operating in this State. The |
|
|
|
SB1828 |
- 15 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| assessment shall be in proportion to the business done in this |
2 |
| State. |
3 |
| (b) The Secretary shall give each PBM notice of the |
4 |
| assessment, which shall be paid to the Secretary on or before |
5 |
| April 1 of each year. |
6 |
| (c) If an assessment is not paid by the prescribed date, |
7 |
| the amount of any assessment, plus a penalty, the license of |
8 |
| the defaulting PBM may be revoked or suspended by the Secretary |
9 |
| until the assessment and any penalty has been paid. |
10 |
| Section 100. Assessment; Board. |
11 |
| (a) The expense of administering this Act, including the |
12 |
| costs incurred by the Board, shall be assessed annually by the |
13 |
| Board against all PBMs operating in this State. The assessment |
14 |
| shall be in proportion to the business done in this State. |
15 |
| (b) The Board shall give each PBM notice of the assessment, |
16 |
| which shall be paid to the Board on or before April 1 of each |
17 |
| year. |
18 |
| (c) If an assessment is not paid by the prescribed date, |
19 |
| the amount of any assessment, plus a penalty, the license of |
20 |
| the defaulting PBM may be revoked or suspended by the Board |
21 |
| until the assessment and any penalty has been paid. |
22 |
| Section 105. Rulemaking; Secretary and Board. The |
23 |
| Secretary and the Board may adopt rules necessary to carry out |
24 |
| the provisions of this Act. These rules may include the |
25 |
| definition of terms, the use of prescribed forms, reporting |
26 |
| requirements, prohibited practices, and enforcement |
27 |
| procedures. The rules shall be subject to review in accordance |
28 |
| with general rules of administrative rulemaking and review of |
29 |
| regulations. |
30 |
| Section 110. Rulemaking; Department. The Department shall |
31 |
| define the enforcement process that shall be implemented under |
32 |
| this Act, including grounds for license revocation, fines, |
33 |
| suspension, and reinstatement and shall adopt rules concerning |
|
|
|
SB1828 |
- 16 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| unfair trade practices, protections for privacy and |
2 |
| confidentiality of covered persons, and the prohibition of |
3 |
| discrimination and false and misleading advertising. |
4 |
| Section 115. Severability. The provisions of this Act are |
5 |
| severable under Section 1.31 of the Statute on Statutes.
|
6 |
| Section 900. The State Finance Act is amended by changing |
7 |
| Section 8g and by adding Section 5.640 as follows: |
8 |
| (30 ILCS 105/5.640 new)
|
9 |
| Sec. 5.640. The Pharmacy Benefits Management Fund.
|
10 |
| (30 ILCS 105/8g)
|
11 |
| Sec. 8g. Fund transfers.
|
12 |
| (a) In addition to any other transfers that may be provided |
13 |
| for by law, as
soon as may be practical after the effective |
14 |
| date of this amendatory Act of
the 91st General Assembly, the |
15 |
| State Comptroller shall direct and the State
Treasurer shall |
16 |
| transfer the sum of $10,000,000 from the General Revenue Fund
|
17 |
| to the Motor Vehicle License Plate Fund created by Senate Bill |
18 |
| 1028 of the 91st
General Assembly.
|
19 |
| (b) In addition to any other transfers that may be provided |
20 |
| for by law, as
soon as may be practical after the effective |
21 |
| date of this amendatory Act of
the 91st General Assembly, the |
22 |
| State Comptroller shall direct and the State
Treasurer shall |
23 |
| transfer the sum of $25,000,000 from the General Revenue Fund
|
24 |
| to the Fund for Illinois' Future created by Senate Bill 1066 of |
25 |
| the 91st
General Assembly.
|
26 |
| (c) In addition to any other transfers that may be provided |
27 |
| for by law,
on August 30 of each fiscal year's license period, |
28 |
| the Illinois Liquor Control
Commission shall direct and the |
29 |
| State Comptroller and State Treasurer shall
transfer from the |
30 |
| General Revenue Fund to the Youth Alcoholism and Substance
|
31 |
| Abuse Prevention Fund an amount equal to the number of retail |
32 |
| liquor licenses
issued for that fiscal year multiplied by $50.
|
|
|
|
SB1828 |
- 17 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| (d) The payments to programs required under subsection (d) |
2 |
| of Section 28.1
of the Horse Racing Act of 1975 shall be made, |
3 |
| pursuant to appropriation, from
the special funds referred to |
4 |
| in the statutes cited in that subsection, rather
than directly |
5 |
| from the General Revenue Fund.
|
6 |
| Beginning January 1, 2000, on the first day of each month, |
7 |
| or as soon
as may be practical thereafter, the State |
8 |
| Comptroller shall direct and the
State Treasurer shall transfer |
9 |
| from the General Revenue Fund to each of the
special funds from |
10 |
| which payments are to be made under Section 28.1(d) of the
|
11 |
| Horse Racing Act of 1975 an amount equal to 1/12 of the annual |
12 |
| amount required
for those payments from that special fund, |
13 |
| which annual amount shall not exceed
the annual amount for |
14 |
| those payments from that special fund for the calendar
year |
15 |
| 1998. The special funds to which transfers shall be made under |
16 |
| this
subsection (d) include, but are not necessarily limited |
17 |
| to, the Agricultural
Premium Fund; the Metropolitan Exposition |
18 |
| Auditorium and Office Building Fund;
the Fair and Exposition |
19 |
| Fund; the Standardbred Breeders Fund; the Thoroughbred
|
20 |
| Breeders Fund; and the Illinois Veterans' Rehabilitation Fund.
|
21 |
| (e) In addition to any other transfers that may be provided |
22 |
| for by law,
as soon as may be practical after the effective |
23 |
| date of this amendatory Act of
the 91st General Assembly, but |
24 |
| in no event later than June 30, 2000, the State
Comptroller |
25 |
| shall direct and the State Treasurer shall transfer the sum of
|
26 |
| $15,000,000 from the General Revenue Fund to the Fund for |
27 |
| Illinois' Future.
|
28 |
| (f) In addition to any other transfers that may be provided |
29 |
| for by law,
as soon as may be practical after the effective |
30 |
| date of this amendatory Act of
the 91st General Assembly, but |
31 |
| in no event later than June 30, 2000, the State
Comptroller |
32 |
| shall direct and the State Treasurer shall transfer the sum of
|
33 |
| $70,000,000 from the General Revenue Fund to the Long-Term Care |
34 |
| Provider
Fund.
|
35 |
| (f-1) In fiscal year 2002, in addition to any other |
36 |
| transfers that may
be provided for by law, at the direction of |
|
|
|
SB1828 |
- 18 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| and upon notification from the
Governor, the State Comptroller |
2 |
| shall direct and the State Treasurer shall
transfer amounts not |
3 |
| exceeding a total of $160,000,000 from the General
Revenue Fund |
4 |
| to the Long-Term Care Provider Fund.
|
5 |
| (g) In addition to any other transfers that may be provided |
6 |
| for by law,
on July 1, 2001, or as soon thereafter as may be |
7 |
| practical, the State
Comptroller shall direct and the State |
8 |
| Treasurer shall transfer the sum of
$1,200,000 from the General |
9 |
| Revenue Fund to the Violence Prevention Fund.
|
10 |
| (h) In each of fiscal years 2002 through 2004, but not
|
11 |
| thereafter, in
addition to any other transfers that may be |
12 |
| provided for by law, the State
Comptroller shall direct and the |
13 |
| State Treasurer shall transfer $5,000,000
from the General |
14 |
| Revenue Fund to the Tourism Promotion Fund.
|
15 |
| (i) On or after July 1, 2001 and until May 1, 2002, in |
16 |
| addition to any
other transfers that may be provided for by |
17 |
| law, at the direction of and upon
notification from the |
18 |
| Governor, the State Comptroller shall direct and the
State |
19 |
| Treasurer shall transfer amounts not exceeding a total of |
20 |
| $80,000,000
from the General Revenue Fund to the Tobacco |
21 |
| Settlement Recovery Fund.
Any amounts so transferred shall be |
22 |
| re-transferred by the State Comptroller
and the State Treasurer |
23 |
| from the Tobacco Settlement Recovery Fund to the
General |
24 |
| Revenue Fund at the direction of and upon notification from the
|
25 |
| Governor, but in any event on or before June 30, 2002.
|
26 |
| (i-1) On or after July 1, 2002 and until May 1, 2003, in |
27 |
| addition to any
other transfers that may be provided for by |
28 |
| law, at the direction of and upon
notification from the |
29 |
| Governor, the State Comptroller shall direct and the
State |
30 |
| Treasurer shall transfer amounts not exceeding a total of |
31 |
| $80,000,000
from the General Revenue Fund to the Tobacco |
32 |
| Settlement Recovery Fund.
Any amounts so transferred shall be |
33 |
| re-transferred by the State Comptroller
and the State Treasurer |
34 |
| from the Tobacco Settlement Recovery Fund to the
General |
35 |
| Revenue Fund at the direction of and upon notification from the
|
36 |
| Governor, but in any event on or before June 30, 2003.
|
|
|
|
SB1828 |
- 19 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| (j) On or after July 1, 2001 and no later than June 30, |
2 |
| 2002, in addition to
any other transfers that may be provided |
3 |
| for by law, at the direction of and
upon notification from the |
4 |
| Governor, the State Comptroller shall direct and the
State |
5 |
| Treasurer shall transfer amounts not to exceed the following |
6 |
| sums into
the Statistical Services Revolving Fund:
|
|
7 | | From the General Revenue Fund ................. |
$8,450,000 |
|
8 | | From the Public Utility Fund .................. |
1,700,000 |
|
9 | | From the Transportation Regulatory Fund ....... |
2,650,000 |
|
10 | | From the Title III Social Security and |
|
|
11 | | Employment Fund .............................. |
3,700,000 |
|
12 | | From the Professions Indirect Cost Fund ....... |
4,050,000 |
|
13 | | From the Underground Storage Tank Fund ........ |
550,000 |
|
14 | | From the Agricultural Premium Fund ............ |
750,000 |
|
15 | | From the State Pensions Fund .................. |
200,000 |
|
16 | | From the Road Fund ............................ |
2,000,000 |
|
17 | | From the Health Facilities |
|
|
18 | | Planning Fund ................................ |
1,000,000 |
|
19 | | From the Savings and Residential Finance |
|
|
20 | | Regulatory Fund .............................. |
130,800 |
|
21 | | From the Appraisal Administration Fund ........ |
28,600 |
|
22 | | From the Pawnbroker Regulation Fund ........... |
3,600 |
|
23 | | From the Auction Regulation |
|
|
24 | | Administration Fund .......................... |
35,800 |
|
25 | | From the Bank and Trust Company Fund .......... |
634,800 |
|
26 | | From the Real Estate License |
|
|
27 | | Administration Fund .......................... |
313,600 |
|
28 |
| (k) In addition to any other transfers that may be provided |
29 |
| for by law,
as soon as may be practical after the effective |
30 |
| date of this amendatory Act of
the 92nd General Assembly, the |
31 |
| State Comptroller shall direct and the State
Treasurer shall |
32 |
| transfer the sum of $2,000,000 from the General Revenue Fund
to |
33 |
| the Teachers Health Insurance Security Fund.
|
34 |
| (k-1) In addition to any other transfers that may be |
35 |
| provided for by
law, on July 1, 2002, or as soon as may be |
36 |
| practical thereafter, the State
Comptroller shall direct and |
|
|
|
SB1828 |
- 20 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| the State Treasurer shall transfer the sum of
$2,000,000 from |
2 |
| the General Revenue Fund to the Teachers Health Insurance
|
3 |
| Security Fund.
|
4 |
| (k-2) In addition to any other transfers that may be |
5 |
| provided for by
law, on July 1, 2003, or as soon as may be |
6 |
| practical thereafter, the State
Comptroller shall direct and |
7 |
| the State Treasurer shall transfer the sum of
$2,000,000 from |
8 |
| the General Revenue Fund to the Teachers Health Insurance
|
9 |
| Security Fund.
|
10 |
| (k-3) On or after July 1, 2002 and no later than June 30, |
11 |
| 2003, in
addition to any other transfers that may be provided |
12 |
| for by law, at the
direction of and upon notification from the |
13 |
| Governor, the State Comptroller
shall direct and the State |
14 |
| Treasurer shall transfer amounts not to exceed the
following |
15 |
| sums into the Statistical Services Revolving Fund:
|
|
16 | | Appraisal Administration Fund ................. |
$150,000 |
|
17 | | General Revenue Fund .......................... |
10,440,000 |
|
18 | | Savings and Residential Finance |
|
|
19 | | Regulatory Fund ........................... |
200,000 |
|
20 | | State Pensions Fund ........................... |
100,000 |
|
21 | | Bank and Trust Company Fund ................... |
100,000 |
|
22 | | Professions Indirect Cost Fund ................ |
3,400,000 |
|
23 | | Public Utility Fund ........................... |
2,081,200 |
|
24 | | Real Estate License Administration Fund ....... |
150,000 |
|
25 | | Title III Social Security and |
|
|
26 | | Employment Fund ........................... |
1,000,000 |
|
27 | | Transportation Regulatory Fund ................ |
3,052,100 |
|
28 | | Underground Storage Tank Fund ................. |
50,000 |
|
29 |
| (l) In addition to any other transfers that may be provided |
30 |
| for by law, on
July 1, 2002, or as soon as may be practical |
31 |
| thereafter, the State Comptroller
shall direct and the State |
32 |
| Treasurer shall transfer the sum of $3,000,000 from
the General |
33 |
| Revenue Fund to the Presidential Library and Museum Operating
|
34 |
| Fund.
|
35 |
| (m) In addition to any other transfers that may be provided |
36 |
| for by law, on
July 1, 2002 and on the effective date of this |
|
|
|
SB1828 |
- 21 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| amendatory Act of the 93rd
General Assembly, or as soon |
2 |
| thereafter as may be practical, the State Comptroller
shall |
3 |
| direct and the State Treasurer shall transfer the sum of |
4 |
| $1,200,000 from
the General Revenue Fund to the Violence |
5 |
| Prevention Fund.
|
6 |
| (n) In addition to any other transfers that may be provided |
7 |
| for by law,
on July 1,
2003, or as soon thereafter as may be |
8 |
| practical, the State Comptroller shall
direct and the
State |
9 |
| Treasurer shall transfer the sum of $6,800,000 from the General |
10 |
| Revenue
Fund to
the DHS Recoveries Trust Fund.
|
11 |
| (o) On or after July 1, 2003, and no later than June 30, |
12 |
| 2004, in
addition to any
other transfers that may be provided |
13 |
| for by law, at the direction of and upon
notification
from the |
14 |
| Governor, the State Comptroller shall direct and the State |
15 |
| Treasurer
shall
transfer amounts not to exceed the following |
16 |
| sums into the Vehicle Inspection
Fund:
|
|
17 | | From the Underground Storage Tank Fund ....... |
$35,000,000. |
|
18 |
| (p) On or after July 1, 2003 and until May 1, 2004, in |
19 |
| addition to any
other
transfers that may be provided for by |
20 |
| law, at the direction of and upon
notification from
the |
21 |
| Governor, the State Comptroller shall direct and the State |
22 |
| Treasurer shall
transfer
amounts not exceeding a total of |
23 |
| $80,000,000 from the General Revenue Fund to
the
Tobacco |
24 |
| Settlement Recovery Fund. Any amounts so transferred shall be
|
25 |
| re-transferred
from the Tobacco Settlement Recovery Fund to the |
26 |
| General Revenue Fund at the
direction of and upon notification |
27 |
| from the Governor, but in any event on or
before June
30, 2004.
|
28 |
| (q) In addition to any other transfers that may be provided |
29 |
| for by law, on
July 1,
2003, or as soon as may be practical |
30 |
| thereafter, the State Comptroller shall
direct and the
State |
31 |
| Treasurer shall transfer the sum of $5,000,000 from the General |
32 |
| Revenue
Fund to
the Illinois Military Family Relief Fund.
|
33 |
| (r) In addition to any other transfers that may be provided |
34 |
| for by law, on
July 1,
2003, or as soon as may be practical |
35 |
| thereafter, the State Comptroller shall
direct and the
State |
36 |
| Treasurer shall transfer the sum of $1,922,000 from the General |
|
|
|
SB1828 |
- 22 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| Revenue
Fund to
the Presidential Library and Museum Operating |
2 |
| Fund.
|
3 |
| (s) In addition to any other transfers that may be provided |
4 |
| for by law, on
or after
July 1, 2003, the State Comptroller |
5 |
| shall direct and the State Treasurer shall
transfer the
sum of |
6 |
| $4,800,000 from the Statewide Economic Development Fund to the |
7 |
| General
Revenue Fund.
|
8 |
| (t) In addition to any other transfers that may be provided |
9 |
| for by law, on
or after
July 1, 2003, the State Comptroller |
10 |
| shall direct and the State Treasurer shall
transfer the
sum of |
11 |
| $50,000,000 from the General Revenue Fund to the Budget |
12 |
| Stabilization
Fund.
|
13 |
| (u) On or after July 1, 2004 and until May 1, 2005, in |
14 |
| addition to any other transfers that may be provided for by |
15 |
| law, at the direction of and upon notification from the |
16 |
| Governor, the State Comptroller shall direct and the State |
17 |
| Treasurer shall transfer amounts not exceeding a total of |
18 |
| $80,000,000 from the General Revenue Fund to the Tobacco |
19 |
| Settlement Recovery Fund. Any amounts so transferred shall be |
20 |
| retransferred by the State Comptroller and the State Treasurer |
21 |
| from the Tobacco Settlement Recovery Fund to the General |
22 |
| Revenue Fund at the direction of and upon notification from the |
23 |
| Governor, but in any event on or before June 30, 2005.
|
24 |
| (v) In addition to any other transfers that may be provided |
25 |
| for by law, on July 1, 2004, or as soon thereafter as may be |
26 |
| practical, the State Comptroller shall direct and the State |
27 |
| Treasurer shall transfer the sum of $1,200,000 from the General |
28 |
| Revenue Fund to the Violence Prevention Fund. |
29 |
| (w) In addition to any other transfers that may be provided |
30 |
| for by law, on July 1, 2004, or as soon thereafter as may be |
31 |
| practical, the State Comptroller shall direct and the State |
32 |
| Treasurer shall transfer the sum of $6,445,000 from the General |
33 |
| Revenue Fund to the Presidential Library and Museum Operating |
34 |
| Fund.
|
35 |
| (x) In addition to any other transfers that may be provided |
36 |
| for by law, on January 15, 2005, or as soon thereafter as may |
|
|
|
SB1828 |
- 23 - |
LRB094 11306 RAS 42120 b |
|
|
1 |
| be practical, the State Comptroller shall direct and the State |
2 |
| Treasurer shall transfer to the General Revenue Fund the |
3 |
| following sums: |
4 |
| From the State Crime Laboratory Fund, $200,000; |
5 |
| From the State Police Wireless Service Emergency Fund, |
6 |
| $200,000; |
7 |
| From the State Offender DNA Identification System |
8 |
| Fund, $800,000; and |
9 |
| From the State Police Whistleblower Reward and |
10 |
| Protection Fund, $500,000.
|
11 |
| (y) No transfers shall be made to the General Revenue Fund |
12 |
| from the Pharmacy Benefits Management Fund.
|
13 |
| (Source: P.A. 92-11, eff. 6-11-01; 92-505, eff. 12-20-01; |
14 |
| 92-600, eff. 6-28-02; 93-32, eff. 6-20-03; 93-648, eff. 1-8-04; |
15 |
| 93-839, eff. 7-30-04; 93-1067, eff. 1-15-05.)
|
16 |
| Section 999. Effective date. This Act takes effect upon |
17 |
| becoming law.
|