Illinois General Assembly - Full Text of HB4548
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Full Text of HB4548  103rd General Assembly


Rep. Thaddeus Jones

Filed: 4/1/2024





10300HB4548ham001LRB103 35901 RPS 70762 a


2    AMENDMENT NO. ______. Amend House Bill 4548 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Freedom of Information Act is amended by
5changing Section 7 as follows:
6    (5 ILCS 140/7)
7    Sec. 7. Exemptions.
8    (1) When a request is made to inspect or copy a public
9record that contains information that is exempt from
10disclosure under this Section, but also contains information
11that is not exempt from disclosure, the public body may elect
12to redact the information that is exempt. The public body
13shall make the remaining information available for inspection
14and copying. Subject to this requirement, the following shall
15be exempt from inspection and copying:
16        (a) Information specifically prohibited from



10300HB4548ham001- 2 -LRB103 35901 RPS 70762 a

1    disclosure by federal or State law or rules and
2    regulations implementing federal or State law.
3        (b) Private information, unless disclosure is required
4    by another provision of this Act, a State or federal law,
5    or a court order.
6        (b-5) Files, documents, and other data or databases
7    maintained by one or more law enforcement agencies and
8    specifically designed to provide information to one or
9    more law enforcement agencies regarding the physical or
10    mental status of one or more individual subjects.
11        (c) Personal information contained within public
12    records, the disclosure of which would constitute a
13    clearly unwarranted invasion of personal privacy, unless
14    the disclosure is consented to in writing by the
15    individual subjects of the information. "Unwarranted
16    invasion of personal privacy" means the disclosure of
17    information that is highly personal or objectionable to a
18    reasonable person and in which the subject's right to
19    privacy outweighs any legitimate public interest in
20    obtaining the information. The disclosure of information
21    that bears on the public duties of public employees and
22    officials shall not be considered an invasion of personal
23    privacy.
24        (d) Records in the possession of any public body
25    created in the course of administrative enforcement
26    proceedings, and any law enforcement or correctional



10300HB4548ham001- 3 -LRB103 35901 RPS 70762 a

1    agency for law enforcement purposes, but only to the
2    extent that disclosure would:
3            (i) interfere with pending or actually and
4        reasonably contemplated law enforcement proceedings
5        conducted by any law enforcement or correctional
6        agency that is the recipient of the request;
7            (ii) interfere with active administrative
8        enforcement proceedings conducted by the public body
9        that is the recipient of the request;
10            (iii) create a substantial likelihood that a
11        person will be deprived of a fair trial or an impartial
12        hearing;
13            (iv) unavoidably disclose the identity of a
14        confidential source, confidential information
15        furnished only by the confidential source, or persons
16        who file complaints with or provide information to
17        administrative, investigative, law enforcement, or
18        penal agencies; except that the identities of
19        witnesses to traffic crashes, traffic crash reports,
20        and rescue reports shall be provided by agencies of
21        local government, except when disclosure would
22        interfere with an active criminal investigation
23        conducted by the agency that is the recipient of the
24        request;
25            (v) disclose unique or specialized investigative
26        techniques other than those generally used and known



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1        or disclose internal documents of correctional
2        agencies related to detection, observation, or
3        investigation of incidents of crime or misconduct, and
4        disclosure would result in demonstrable harm to the
5        agency or public body that is the recipient of the
6        request;
7            (vi) endanger the life or physical safety of law
8        enforcement personnel or any other person; or
9            (vii) obstruct an ongoing criminal investigation
10        by the agency that is the recipient of the request.
11        (d-5) A law enforcement record created for law
12    enforcement purposes and contained in a shared electronic
13    record management system if the law enforcement agency
14    that is the recipient of the request did not create the
15    record, did not participate in or have a role in any of the
16    events which are the subject of the record, and only has
17    access to the record through the shared electronic record
18    management system.
19        (d-6) Records contained in the Officer Professional
20    Conduct Database under Section 9.2 of the Illinois Police
21    Training Act, except to the extent authorized under that
22    Section. This includes the documents supplied to the
23    Illinois Law Enforcement Training Standards Board from the
24    Illinois State Police and Illinois State Police Merit
25    Board.
26        (d-7) Information gathered or records created from the



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1    use of automatic license plate readers in connection with
2    Section 2-130 of the Illinois Vehicle Code.
3        (e) Records that relate to or affect the security of
4    correctional institutions and detention facilities.
5        (e-5) Records requested by persons committed to the
6    Department of Corrections, Department of Human Services
7    Division of Mental Health, or a county jail if those
8    materials are available in the library of the correctional
9    institution or facility or jail where the inmate is
10    confined.
11        (e-6) Records requested by persons committed to the
12    Department of Corrections, Department of Human Services
13    Division of Mental Health, or a county jail if those
14    materials include records from staff members' personnel
15    files, staff rosters, or other staffing assignment
16    information.
17        (e-7) Records requested by persons committed to the
18    Department of Corrections or Department of Human Services
19    Division of Mental Health if those materials are available
20    through an administrative request to the Department of
21    Corrections or Department of Human Services Division of
22    Mental Health.
23        (e-8) Records requested by a person committed to the
24    Department of Corrections, Department of Human Services
25    Division of Mental Health, or a county jail, the
26    disclosure of which would result in the risk of harm to any



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1    person or the risk of an escape from a jail or correctional
2    institution or facility.
3        (e-9) Records requested by a person in a county jail
4    or committed to the Department of Corrections or
5    Department of Human Services Division of Mental Health,
6    containing personal information pertaining to the person's
7    victim or the victim's family, including, but not limited
8    to, a victim's home address, home telephone number, work
9    or school address, work telephone number, social security
10    number, or any other identifying information, except as
11    may be relevant to a requester's current or potential case
12    or claim.
13        (e-10) Law enforcement records of other persons
14    requested by a person committed to the Department of
15    Corrections, Department of Human Services Division of
16    Mental Health, or a county jail, including, but not
17    limited to, arrest and booking records, mug shots, and
18    crime scene photographs, except as these records may be
19    relevant to the requester's current or potential case or
20    claim.
21        (f) Preliminary drafts, notes, recommendations,
22    memoranda, and other records in which opinions are
23    expressed, or policies or actions are formulated, except
24    that a specific record or relevant portion of a record
25    shall not be exempt when the record is publicly cited and
26    identified by the head of the public body. The exemption



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1    provided in this paragraph (f) extends to all those
2    records of officers and agencies of the General Assembly
3    that pertain to the preparation of legislative documents.
4        (g) Trade secrets and commercial or financial
5    information obtained from a person or business where the
6    trade secrets or commercial or financial information are
7    furnished under a claim that they are proprietary,
8    privileged, or confidential, and that disclosure of the
9    trade secrets or commercial or financial information would
10    cause competitive harm to the person or business, and only
11    insofar as the claim directly applies to the records
12    requested.
13        The information included under this exemption includes
14    all trade secrets and commercial or financial information
15    obtained by a public body, including a public pension
16    fund, from a private equity fund or a privately held
17    company within the investment portfolio of a private
18    equity fund as a result of either investing or evaluating
19    a potential investment of public funds in a private equity
20    fund. The exemption contained in this item does not apply
21    to the aggregate financial performance information of a
22    private equity fund, nor to the identity of the fund's
23    managers or general partners. The exemption contained in
24    this item does not apply to the identity of a privately
25    held company within the investment portfolio of a private
26    equity fund, unless the disclosure of the identity of a



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1    privately held company may cause competitive harm.
2        Nothing contained in this paragraph (g) shall be
3    construed to prevent a person or business from consenting
4    to disclosure.
5        (h) Proposals and bids for any contract, grant, or
6    agreement, including information which if it were
7    disclosed would frustrate procurement or give an advantage
8    to any person proposing to enter into a contractor
9    agreement with the body, until an award or final selection
10    is made. Information prepared by or for the body in
11    preparation of a bid solicitation shall be exempt until an
12    award or final selection is made.
13        (i) Valuable formulae, computer geographic systems,
14    designs, drawings, and research data obtained or produced
15    by any public body when disclosure could reasonably be
16    expected to produce private gain or public loss. The
17    exemption for "computer geographic systems" provided in
18    this paragraph (i) does not extend to requests made by
19    news media as defined in Section 2 of this Act when the
20    requested information is not otherwise exempt and the only
21    purpose of the request is to access and disseminate
22    information regarding the health, safety, welfare, or
23    legal rights of the general public.
24        (j) The following information pertaining to
25    educational matters:
26            (i) test questions, scoring keys, and other



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1        examination data used to administer an academic
2        examination;
3            (ii) information received by a primary or
4        secondary school, college, or university under its
5        procedures for the evaluation of faculty members by
6        their academic peers;
7            (iii) information concerning a school or
8        university's adjudication of student disciplinary
9        cases, but only to the extent that disclosure would
10        unavoidably reveal the identity of the student; and
11            (iv) course materials or research materials used
12        by faculty members.
13        (k) Architects' plans, engineers' technical
14    submissions, and other construction related technical
15    documents for projects not constructed or developed in
16    whole or in part with public funds and the same for
17    projects constructed or developed with public funds,
18    including, but not limited to, power generating and
19    distribution stations and other transmission and
20    distribution facilities, water treatment facilities,
21    airport facilities, sport stadiums, convention centers,
22    and all government owned, operated, or occupied buildings,
23    but only to the extent that disclosure would compromise
24    security.
25        (l) Minutes of meetings of public bodies closed to the
26    public as provided in the Open Meetings Act until the



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1    public body makes the minutes available to the public
2    under Section 2.06 of the Open Meetings Act.
3        (m) Communications between a public body and an
4    attorney or auditor representing the public body that
5    would not be subject to discovery in litigation, and
6    materials prepared or compiled by or for a public body in
7    anticipation of a criminal, civil, or administrative
8    proceeding upon the request of an attorney advising the
9    public body, and materials prepared or compiled with
10    respect to internal audits of public bodies.
11        (n) Records relating to a public body's adjudication
12    of employee grievances or disciplinary cases; however,
13    this exemption shall not extend to the final outcome of
14    cases in which discipline is imposed.
15        (o) Administrative or technical information associated
16    with automated data processing operations, including, but
17    not limited to, software, operating protocols, computer
18    program abstracts, file layouts, source listings, object
19    modules, load modules, user guides, documentation
20    pertaining to all logical and physical design of
21    computerized systems, employee manuals, and any other
22    information that, if disclosed, would jeopardize the
23    security of the system or its data or the security of
24    materials exempt under this Section.
25        (p) Records relating to collective negotiating matters
26    between public bodies and their employees or



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1    representatives, except that any final contract or
2    agreement shall be subject to inspection and copying.
3        (q) Test questions, scoring keys, and other
4    examination data used to determine the qualifications of
5    an applicant for a license or employment.
6        (r) The records, documents, and information relating
7    to real estate purchase negotiations until those
8    negotiations have been completed or otherwise terminated.
9    With regard to a parcel involved in a pending or actually
10    and reasonably contemplated eminent domain proceeding
11    under the Eminent Domain Act, records, documents, and
12    information relating to that parcel shall be exempt except
13    as may be allowed under discovery rules adopted by the
14    Illinois Supreme Court. The records, documents, and
15    information relating to a real estate sale shall be exempt
16    until a sale is consummated.
17        (s) Any and all proprietary information and records
18    related to the operation of an intergovernmental risk
19    management association or self-insurance pool or jointly
20    self-administered health and accident cooperative or pool.
21    Insurance or self-insurance (including any
22    intergovernmental risk management association or
23    self-insurance pool) claims, loss or risk management
24    information, records, data, advice, or communications.
25        (t) Information contained in or related to
26    examination, operating, or condition reports prepared by,



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1    on behalf of, or for the use of a public body responsible
2    for the regulation or supervision of financial
3    institutions, insurance companies, or pharmacy benefit
4    managers, unless disclosure is otherwise required by State
5    law.
6        (u) Information that would disclose or might lead to
7    the disclosure of secret or confidential information,
8    codes, algorithms, programs, or private keys intended to
9    be used to create electronic signatures under the Uniform
10    Electronic Transactions Act.
11        (v) Vulnerability assessments, security measures, and
12    response policies or plans that are designed to identify,
13    prevent, or respond to potential attacks upon a
14    community's population or systems, facilities, or
15    installations, but only to the extent that disclosure
16    could reasonably be expected to expose the vulnerability
17    or jeopardize the effectiveness of the measures, policies,
18    or plans, or the safety of the personnel who implement
19    them or the public. Information exempt under this item may
20    include such things as details pertaining to the
21    mobilization or deployment of personnel or equipment, to
22    the operation of communication systems or protocols, to
23    cybersecurity vulnerabilities, or to tactical operations.
24        (w) (Blank).
25        (x) Maps and other records regarding the location or
26    security of generation, transmission, distribution,



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1    storage, gathering, treatment, or switching facilities
2    owned by a utility, by a power generator, or by the
3    Illinois Power Agency.
4        (y) Information contained in or related to proposals,
5    bids, or negotiations related to electric power
6    procurement under Section 1-75 of the Illinois Power
7    Agency Act and Section 16-111.5 of the Public Utilities
8    Act that is determined to be confidential and proprietary
9    by the Illinois Power Agency or by the Illinois Commerce
10    Commission.
11        (z) Information about students exempted from
12    disclosure under Section 10-20.38 or 34-18.29 of the
13    School Code, and information about undergraduate students
14    enrolled at an institution of higher education exempted
15    from disclosure under Section 25 of the Illinois Credit
16    Card Marketing Act of 2009.
17        (aa) Information the disclosure of which is exempted
18    under the Viatical Settlements Act of 2009.
19        (bb) Records and information provided to a mortality
20    review team and records maintained by a mortality review
21    team appointed under the Department of Juvenile Justice
22    Mortality Review Team Act.
23        (cc) Information regarding interments, entombments, or
24    inurnments of human remains that are submitted to the
25    Cemetery Oversight Database under the Cemetery Care Act or
26    the Cemetery Oversight Act, whichever is applicable.



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1        (dd) Correspondence and records (i) that may not be
2    disclosed under Section 11-9 of the Illinois Public Aid
3    Code or (ii) that pertain to appeals under Section 11-8 of
4    the Illinois Public Aid Code.
5        (ee) The names, addresses, or other personal
6    information of persons who are minors and are also
7    participants and registrants in programs of park
8    districts, forest preserve districts, conservation
9    districts, recreation agencies, and special recreation
10    associations.
11        (ff) The names, addresses, or other personal
12    information of participants and registrants in programs of
13    park districts, forest preserve districts, conservation
14    districts, recreation agencies, and special recreation
15    associations where such programs are targeted primarily to
16    minors.
17        (gg) Confidential information described in Section
18    1-100 of the Illinois Independent Tax Tribunal Act of
19    2012.
20        (hh) The report submitted to the State Board of
21    Education by the School Security and Standards Task Force
22    under item (8) of subsection (d) of Section 2-3.160 of the
23    School Code and any information contained in that report.
24        (ii) Records requested by persons committed to or
25    detained by the Department of Human Services under the
26    Sexually Violent Persons Commitment Act or committed to



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1    the Department of Corrections under the Sexually Dangerous
2    Persons Act if those materials: (i) are available in the
3    library of the facility where the individual is confined;
4    (ii) include records from staff members' personnel files,
5    staff rosters, or other staffing assignment information;
6    or (iii) are available through an administrative request
7    to the Department of Human Services or the Department of
8    Corrections.
9        (jj) Confidential information described in Section
10    5-535 of the Civil Administrative Code of Illinois.
11        (kk) The public body's credit card numbers, debit card
12    numbers, bank account numbers, Federal Employer
13    Identification Number, security code numbers, passwords,
14    and similar account information, the disclosure of which
15    could result in identity theft or impression or defrauding
16    of a governmental entity or a person.
17        (ll) Records concerning the work of the threat
18    assessment team of a school district, including, but not
19    limited to, any threat assessment procedure under the
20    School Safety Drill Act and any information contained in
21    the procedure.
22        (mm) Information prohibited from being disclosed under
23    subsections (a) and (b) of Section 15 of the Student
24    Confidential Reporting Act.
25        (nn) Proprietary information submitted to the
26    Environmental Protection Agency under the Drug Take-Back



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1    Act.
2        (oo) Records described in subsection (f) of Section
3    3-5-1 of the Unified Code of Corrections.
4        (pp) Any and all information regarding burials,
5    interments, or entombments of human remains as required to
6    be reported to the Department of Natural Resources
7    pursuant either to the Archaeological and Paleontological
8    Resources Protection Act or the Human Remains Protection
9    Act.
10        (qq) (pp) Reports described in subsection (e) of
11    Section 16-15 of the Abortion Care Clinical Training
12    Program Act.
13        (rr) (pp) Information obtained by a certified local
14    health department under the Access to Public Health Data
15    Act.
16        (ss) (pp) For a request directed to a public body that
17    is also a HIPAA-covered entity, all information that is
18    protected health information, including demographic
19    information, that may be contained within or extracted
20    from any record held by the public body in compliance with
21    State and federal medical privacy laws and regulations,
22    including, but not limited to, the Health Insurance
23    Portability and Accountability Act and its regulations, 45
24    CFR Parts 160 and 164. As used in this paragraph,
25    "HIPAA-covered entity" has the meaning given to the term
26    "covered entity" in 45 CFR 160.103 and "protected health



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1    information" has the meaning given to that term in 45 CFR
2    160.103.
3        (tt) Annual reports submitted by pharmacy benefit
4    managers under Section 513b1.5 of the Illinois Insurance
5    Code, except for the summary versions of the reports under
6    paragraph (3) of subsection (b) of Section 513b1.5 of the
7    Illinois Insurance Code.
8    (1.5) Any information exempt from disclosure under the
9Judicial Privacy Act shall be redacted from public records
10prior to disclosure under this Act.
11    (2) A public record that is not in the possession of a
12public body but is in the possession of a party with whom the
13agency has contracted to perform a governmental function on
14behalf of the public body, and that directly relates to the
15governmental function and is not otherwise exempt under this
16Act, shall be considered a public record of the public body,
17for purposes of this Act.
18    (3) This Section does not authorize withholding of
19information or limit the availability of records to the
20public, except as stated in this Section or otherwise provided
21in this Act.
22(Source: P.A. 102-38, eff. 6-25-21; 102-558, eff. 8-20-21;
23102-694, eff. 1-7-22; 102-752, eff. 5-6-22; 102-753, eff.
241-1-23; 102-776, eff. 1-1-23; 102-791, eff. 5-13-22; 102-982,
25eff. 7-1-23; 102-1055, eff. 6-10-22; 103-154, eff. 6-30-23;
26103-423, eff. 1-1-24; 103-446, eff. 8-4-23; 103-462, eff.



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18-4-23; 103-540, eff. 1-1-24; 103-554, eff. 1-1-24; revised
3    Section 10. The Illinois Insurance Code is amended by
4changing Section 513b1 and by adding Section 513b1.5 as
6    (215 ILCS 5/513b1)
7    Sec. 513b1. Pharmacy benefit manager contracts.
8    (a) As used in this Section:
9    "340B drug discount program" means the program established
10under Section 340B of the federal Public Health Service Act,
1142 U.S.C. 256b.
12    "340B entity" means a covered entity as defined in 42
13U.S.C. 256b(a)(4) authorized to participate in the 340B drug
14discount program.
15    "340B pharmacy" means any pharmacy used to dispense 340B
16drugs for a covered entity, whether entity-owned or external.
17    "Biological product" has the meaning ascribed to that term
18in Section 19.5 of the Pharmacy Practice Act.
19    "Covered individual" means a member, participant,
20enrollee, contract holder, policyholder, or beneficiary of a
21health benefit plan who is provided a prescription drug
22benefit by the health benefit plan.
23    "Health benefit plan" means a policy, contract,
24certificate, or agreement entered into, offered, or issued by



10300HB4548ham001- 19 -LRB103 35901 RPS 70762 a

1an insurer to provide, deliver, arrange for, pay for, or
2reimburse any of the costs of physical, mental, or behavioral
3health care services. "Health benefit plan" does not include
4Medicaid managed care organizations, as defined in Section
55-30.1 of the Illinois Public Aid Code, or employee welfare
6benefit plans subject to the federal Employee Retirement
7Income Security Act of 1974.
8    "Maximum allowable cost" means the maximum amount that a
9pharmacy benefit manager will reimburse a pharmacy for the
10cost of a drug.
11    "Maximum allowable cost list" means a list of drugs for
12which a maximum allowable cost has been established by a
13pharmacy benefit manager.
14    "Pharmacy benefit manager" means a person, business, or
15entity, including a wholly or partially owned or controlled
16subsidiary of a pharmacy benefit manager, that provides claims
17processing services or other prescription drug or device
18services, or both, for health benefit plans.
19    "Rebate aggregator" means a person or entity that
20negotiates rebates, discounts, or other fees attributable to
21usage by covered individuals with drug manufacturers on behalf
22of pharmacy benefit managers or their clients and may also be
23involved in contracts that entitle the rebate aggregator or
24its client to receive rebates, discounts, or other fees
25attributable to usage by covered individuals from drug
26manufacturers based on drug utilization or administration.



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1    "Retail price" means the price an individual without
2prescription drug coverage would pay at a retail pharmacy, not
3including a pharmacist dispensing fee.
4    "Spread pricing" means the model of prescription drug
5pricing in which the pharmacy benefit manager charges a health
6benefit plan a contracted price for prescription drugs and the
7contracted price for the prescription drugs differs from the
8amount the pharmacy benefit manager directly or indirectly
9pays the pharmacist or pharmacy for pharmacist services.
10    "Steer" includes, but is not limited to:
11        (1) requiring a covered individual to use only a
12    pharmacy, including a mail-order pharmacy, in which the
13    pharmacy benefit manager maintains an ownership interest
14    or control;
15        (2) offering or implementing a plan design that
16    encourages a covered individual to use a pharmacy in which
17    the pharmacy benefit manager maintains an ownership
18    interest or control, if such plan design increases costs
19    for the covered individual, including requiring a covered
20    individual to pay full costs for a prescription if the
21    covered individual chooses not to use a pharmacy owned or
22    controlled by the pharmacy benefit manager;
23        (3) reimbursing a pharmacy or pharmacist for a
24    pharmaceutical product or pharmacist service in an amount
25    less than the amount that the pharmacy benefit manager
26    reimburses itself or an affiliate for providing the same



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1    product or services, unless the pharmacy or pharmacist
2    contractually agrees to a lower reimbursement amount; or
3        (4) any other actions determined by the Department by
4    rule.
5    "Third-party payer" means any entity that pays for
6prescription drugs on behalf of a patient other than a health
7care provider or sponsor of a plan subject to regulation under
8Medicare Part D, 42 U.S.C. 1395w-101 et seq.
9    (b) A contract between a health insurer and a pharmacy
10benefit manager must require that the pharmacy benefit
12        (1) Update maximum allowable cost pricing information
13    at least every 7 calendar days.
14        (2) Maintain a process that will, in a timely manner,
15    eliminate drugs from maximum allowable cost lists or
16    modify drug prices to remain consistent with changes in
17    pricing data used in formulating maximum allowable cost
18    prices and product availability.
19        (3) Provide access to its maximum allowable cost list
20    to each pharmacy or pharmacy services administrative
21    organization subject to the maximum allowable cost list.
22    Access may include a real-time pharmacy website portal to
23    be able to view the maximum allowable cost list. As used in
24    this Section, "pharmacy services administrative
25    organization" means an entity operating within the State
26    that contracts with independent pharmacies to conduct



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1    business on their behalf with third-party payers. A
2    pharmacy services administrative organization may provide
3    administrative services to pharmacies and negotiate and
4    enter into contracts with third-party payers or pharmacy
5    benefit managers on behalf of pharmacies.
6        (4) Provide a process by which a contracted pharmacy
7    can appeal the provider's reimbursement for a drug subject
8    to maximum allowable cost pricing. The appeals process
9    must, at a minimum, include the following:
10            (A) A requirement that a contracted pharmacy has
11        14 calendar days after the applicable fill date to
12        appeal a maximum allowable cost if the reimbursement
13        for the drug is less than the net amount that the
14        network provider paid to the supplier of the drug.
15            (B) A requirement that a pharmacy benefit manager
16        must respond to a challenge within 14 calendar days of
17        the contracted pharmacy making the claim for which the
18        appeal has been submitted.
19            (C) A telephone number and e-mail address or
20        website to network providers, at which the provider
21        can contact the pharmacy benefit manager to process
22        and submit an appeal.
23            (D) A requirement that, if an appeal is denied,
24        the pharmacy benefit manager must provide the reason
25        for the denial and the name and the national drug code
26        number from national or regional wholesalers.



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1            (E) A requirement that, if an appeal is sustained,
2        the pharmacy benefit manager must make an adjustment
3        in the drug price effective the date the challenge is
4        resolved and make the adjustment applicable to all
5        similarly situated network pharmacy providers, as
6        determined by the managed care organization or
7        pharmacy benefit manager.
8        (5) Allow a plan sponsor whose coverage is
9    administered by the contracting with a pharmacy benefit
10    manager an annual right to audit compliance with the terms
11    of the contract by the pharmacy benefit manager,
12    including, but not limited to, full disclosure of any and
13    all rebate amounts secured, whether product specific or
14    generalized rebates, that were provided to the pharmacy
15    benefit manager by a pharmaceutical manufacturer.
16        (6) Allow a plan sponsor whose coverage is
17    administered by the contracting with a pharmacy benefit
18    manager to request that the pharmacy benefit manager
19    disclose the actual amounts paid by the pharmacy benefit
20    manager to the pharmacy.
21        (7) Provide notice to the plan sponsor and the party
22    contracting with the pharmacy benefit manager of any
23    consideration that the pharmacy benefit manager receives
24    from the manufacturer for dispense as written
25    prescriptions once a generic or biologically similar
26    product becomes available.



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1    (c) In order to place a particular prescription drug on a
2maximum allowable cost list, the pharmacy benefit manager
3must, at a minimum, ensure that:
4        (1) if the drug is a generically equivalent drug, it
5    is listed as therapeutically equivalent and
6    pharmaceutically equivalent "A" or "B" rated in the United
7    States Food and Drug Administration's most recent version
8    of the "Orange Book" or have an NR or NA rating by
9    Medi-Span, Gold Standard, or a similar rating by a
10    nationally recognized reference;
11        (2) the drug is available for purchase by each
12    pharmacy in the State from national or regional
13    wholesalers operating in Illinois; and
14        (3) the drug is not obsolete.
15    (d) A pharmacy benefit manager is prohibited from limiting
16a pharmacist's ability to disclose whether the cost-sharing
17obligation exceeds the retail price for a covered prescription
18drug, and the availability of a more affordable alternative
19drug, if one is available in accordance with Section 42 of the
20Pharmacy Practice Act.
21    (e) A health benefit plan insurer or pharmacy benefit
22manager shall not require a covered individual an insured to
23make a payment for a prescription drug at the point of sale in
24an amount that exceeds the lesser of:
25        (1) the applicable cost-sharing amount; or
26        (2) the retail price of the drug in the absence of



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1    prescription drug coverage.
2    (f) Unless required by law, a contract between a pharmacy
3benefit manager or third-party payer and a 340B entity or 340B
4pharmacy shall not contain any provision that:
5        (1) distinguishes between drugs purchased through the
6    340B drug discount program and other drugs when
7    determining reimbursement or reimbursement methodologies,
8    or contains otherwise less favorable payment terms or
9    reimbursement methodologies for 340B entities or 340B
10    pharmacies when compared to similarly situated non-340B
11    entities;
12        (2) imposes any fee, chargeback, or rate adjustment
13    that is not similarly imposed on similarly situated
14    pharmacies that are not 340B entities or 340B pharmacies;
15        (3) imposes any fee, chargeback, or rate adjustment
16    that exceeds the fee, chargeback, or rate adjustment that
17    is not similarly imposed on similarly situated pharmacies
18    that are not 340B entities or 340B pharmacies;
19        (4) prevents or interferes with an individual's choice
20    to receive a covered prescription drug from a 340B entity
21    or 340B pharmacy through any legally permissible means,
22    except that nothing in this paragraph shall prohibit the
23    establishment of differing copayments or other
24    cost-sharing amounts within the health benefit plan for
25    covered individuals persons who acquire covered
26    prescription drugs from a nonpreferred or nonparticipating



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1    provider;
2        (5) excludes a 340B entity or 340B pharmacy from a
3    pharmacy network on any basis that includes consideration
4    of whether the 340B entity or 340B pharmacy participates
5    in the 340B drug discount program;
6        (6) prevents a 340B entity or 340B pharmacy from using
7    a drug purchased under the 340B drug discount program; or
8        (7) any other provision that discriminates against a
9    340B entity or 340B pharmacy by treating the 340B entity
10    or 340B pharmacy differently than non-340B entities or
11    non-340B pharmacies for any reason relating to the
12    entity's participation in the 340B drug discount program.
13    As used in this subsection, "pharmacy benefit manager" and
14"third-party payer" do not include pharmacy benefit managers
15and third-party payers acting on behalf of a Medicaid program
16or an employee welfare benefit plan subject to the federal
17Employee Retirement Income Security Act of 1974.
18    (f-5) A pharmacy benefit manager or an affiliate acting on
19the pharmacy benefit manager's behalf is prohibited from
20conducting spread pricing in this State.
21    (f-10) A pharmacy benefit manager or an affiliate acting
22on the pharmacy benefit manager's behalf shall not steer a
23covered individual.
24    (f-15) A pharmacy benefit manager or an affiliate acting
25on the pharmacy benefit manager's behalf must remit 100% of
26rebates and fees to the health benefit plan sponsor, consumer,



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1or employer. Records of rebates and fees remitted from the
2pharmacy benefit manager or its contracted party shall be
3retained for 7 years.
4    (f-20) A pharmacy benefit manager may not reimburse a
5pharmacy or pharmacist for a prescription drug or pharmacy
6service in an amount less than the national average drug
7acquisition cost for the prescription drug or pharmacy service
8at the time the drug is administered or dispensed, plus a
9professional dispensing fee of $10.49. However, if the
10national average drug acquisition cost is not available at the
11time a drug is administered or dispensed, a pharmacy benefit
12manager may not reimburse in an amount that is less than the
13wholesale acquisition cost of the drug, as defined in 42
14U.S.C. 1395w-3a(c)(6)(B), plus a professional dispensing fee
15of $10.49.
16    (f-25) A pharmacy benefit manager or an affiliate acting
17on the pharmacy benefit manager's behalf is prohibited from
18limiting a covered individual's access to prescription drugs
19from a pharmacy or pharmacist enrolled with the health benefit
20plan under the terms offered to all pharmacies in the plan
21coverage area by unreasonably designating the covered
22prescription drugs as a specialty drug.
23    (f-30) The contract between the pharmacy benefit manager
24and the insurer or health benefit plan sponsor must allow and
25provide for the pharmacy benefit manager's compliance with an
26audit at least once per calendar year of the rebate and fee



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1records remitted from a pharmacy benefit manager or its
2contracted party to a health benefit plan. Contracts with
3rebate aggregators or drug manufactures must be available for
4audit by health benefit plan sponsors or designated third
5parties at least once per plan year. Audits shall be performed
6by an auditor selected by the health benefit plan sponsor.
7Rebate contracts with rebate aggregators or drug manufactures
8shall be available for audit by health benefit plan sponsors.
9     (g) A violation of this Section by a pharmacy benefit
10manager constitutes an unfair or deceptive act or practice in
11the business of insurance under Section 424.
12     (h) A provision that violates subsection (f) in a
13contract between a pharmacy benefit manager or a third-party
14payer and a 340B entity that is entered into, amended, or
15renewed after July 1, 2022 shall be void and unenforceable.
16     (i)(1) A pharmacy benefit manager may not retaliate
17against a pharmacist or pharmacy for disclosing information in
18a court, in an administrative hearing, before a legislative
19commission or committee, or in any other proceeding, if the
20pharmacist or pharmacy has reasonable cause to believe that
21the disclosed information is evidence of a violation of a
22State or federal law, rule, or regulation.
23    (2) A pharmacy benefit manager may not retaliate against a
24pharmacist or pharmacy for disclosing information to a
25government or law enforcement agency, if the pharmacist or
26pharmacy has reasonable cause to believe that the disclosed



10300HB4548ham001- 29 -LRB103 35901 RPS 70762 a

1information is evidence of a violation of a State or federal
2law, rule, or regulation.
3    (3) A pharmacist or pharmacy shall make commercially
4reasonable efforts to limit the disclosure of confidential and
5proprietary information.
6    (4) Retaliatory actions against a pharmacy or pharmacist
7include cancellation of, restriction of, or refusal to renew
8or offer a contract to a pharmacy solely because the pharmacy
9or pharmacist has:
10        (A) made disclosures of information that the
11    pharmacist or pharmacy has reasonable cause to believe is
12    evidence of a violation of a State or federal law, rule, or
13    regulation;
14        (B) filed complaints with the plan or pharmacy benefit
15    manager; or
16        (C) filed complaints against the plan or pharmacy
17    benefit manager with the Department.
18    (j) This Section applies to contracts entered into or
19renewed on or after July 1, 2022.
20    (k) This Section applies to any health benefit group or
21individual policy of accident and health insurance or managed
22care plan that provides coverage for prescription drugs and
23that is amended, delivered, issued, or renewed on or after
24July 1, 2020.
25(Source: P.A. 102-778, eff. 7-1-22; 103-154, eff. 6-30-23;
26103-453, eff. 8-4-23.)



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1    (215 ILCS 5/513b1.5 new)
2    Sec. 513b1.5. Pharmacy benefit manager reporting
4    (a) A pharmacy benefit manager that provides services for
5a health benefit plan must submit an annual report, by no later
6than September 1, to the health benefit plan sponsor and
7issuer and include the following:
8        (1) information collected from drug manufacturers on
9    copayment assistance;
10        (2) a list of drugs covered by the health benefit
11    plan, including details such as the brand name, generic
12    name, number of participants, number of prescription
13    claims, dosage units, dispensing channel used, wholesale
14    acquisition cost, net cost, and total out-of-pocket
15    spending by covered individual;
16        (3) information on each therapeutic class of drugs;
17        (4) the amount received by the health benefit plan in
18    rebates, fees, or discounts related to drug utilization or
19    spending;
20        (5) total gross spending on prescription drugs;
21        (6) total net spending on prescription drugs by the
22    health benefit plan;
23        (7) any compensation paid to brokers, consultants,
24    advisors, or any other individual or firm for referrals,
25    consideration, or retention by the health benefit plan;



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1    and
2        (8) an explanation of benefit design parameters
3    encouraging or requiring covered individuals to use
4    affiliated pharmacies, the percentage of prescriptions
5    charged by these pharmacies, and a list of drugs dispensed
6    by affiliated pharmacies with their associated costs.
7    (b) Annual reports submitted pursuant to subsection (a):
8        (1) must be written in plain language to ensure ease
9    of reading and accessibility;
10        (2) may only contain summary health information to
11    ensure plan, coverage, or covered individual information
12    remains private and confidential;
13        (3) upon request by a covered individual, must be
14    available in summary format and provide aggregated
15    information to help covered individuals understand their
16    health benefit plan's prescription drug coverage; and
17        (4) must be filed with the Department no later than
18    September 1 of each year via the System for Electronic
19    Rates & Forms Filing. The filing shall include the summary
20    version of the report described in paragraph (3) of this
21    subsection, which shall be marked for public access.
22    (c) A pharmacy benefit manager may petition the Department
23for a filing submission extension. The Director may grant or
24deny the extension within 5 business days.
25    (d) Failure by a pharmacy benefit manager to submit an
26annual report to the Department may result in a fine levied by



10300HB4548ham001- 32 -LRB103 35901 RPS 70762 a

1the Director not to exceed $1,000 per day. Funds derived from
2fines levied shall be deposited into the Insurance Producer
3Administration Fund. Fine information shall be posted on the
4Department's website.
5    (e) A pharmacy benefit manager found in violation of
6subsection (a) or paragraph (4) of subsection (b) may request
7a hearing from the Director within 10 days after being found in
9    (f) Except for the summary versions, the annual reports
10submitted by pharmacy benefit managers are considered
11confidential and privileged for all purposes, including for
12purposes of the Freedom of Information Act, a response to a
13subpoena, or evidence in a civil action.
14    (g) A copy of an adverse decision against a pharmacy
15benefit manager for failing to submit an annual report to the
16Department must be posted to the Department's website.
17    Section 99. Effective date. This Act takes effect July 1,