Illinois 102nd Regular Session Status: In Committee Bipartisan · 11 D · 4 R cosponsors

SB 2008 — INS-PHARMACY BENEFIT MANAGERS

Last action — Session Sine Die

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 102nd Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

In plain language

This bill updates regulations for pharmacy benefit managers and insurance related to prescription drug coverage.

The bill amends the Illinois Insurance Code and Public Aid Code to establish requirements for pharmacy benefit managers and drug formulary coverage. It includes provisions for pricing transparency, appeals processes, and reimbursement for pharmacies under federal programs.

What this means for you
  • Pharmacies: This means pharmacies will have clearer guidelines around pricing disputes and require evidence of intent for chargebacks.

Summary

Amends the Illinois Insurance Code. Provides that if a generic equivalent for a brand name drug is approved by the federal Food and Drug Administration, plans that provide coverage for prescription drugs through the use of a drug formulary that are amended, delivered, issued, or renewed in the State on or after January 1, 2022 shall comply with specified requirements. Provides that the Department of Insurance may adopt rules to implement provisions concerning notice of change of drug formulary. In provisions concerning a contract between a health insurer and a pharmacy benefit manager, provides that a pharmacy benefit manager must update and publish maximum allowable cost pricing information according to specified requirements, must provide a reasonable administrative appeal procedure to allow pharmacies to challenge maximum allowable costs, and must comply with specified requirements if an appeal is denied. Sets forth provisions concerning pharmacy benefit manager contracts; specified requirements that a pharmacy benefit manager shall comply with; specified requirements that an auditing entity shall comply with when conducting a pharmacy audit; and specified requirements concerning pharmacy network access standards. Provides that a violation of specified provisions is an unfair method of competition and unfair and deceptive act or practice in the business of insurance. Sets forth provisions concerning applicability of the Pharmacy Benefit Managers Article of the Illinois Insurance Code, and provisions concerning fiduciary responsibility of a pharmacy benefit manager. Defines terms. Makes other changes. Amends the Illinois Public Aid Code. Sets forth provisions concerning reimbursement of professional dispensing fees and acquisition costs for pharmacy providers. Senate Committee Amendment No. 1 Adds reference to: 215 ILCS 5/513b7 new 215 ILCS 5/513b8 new 215 ILCS 124/35 new Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Provides that a pharmacy may not be subject to a chargeback or recoupment for a clerical or recordkeeping error in a required document or record unless the pharmacy benefit manager can provide proof of intent to commit fraud or such error results in actual financial harm to the pharmacy benefit manager, a health plan managed by the pharmacy benefit manager, or a consumer. Removes various provisions concerning pharmacy benefit manager contracts. Defines "spread pricing". Removes various definitions. Amends the Network Adequacy and Transparency Act. In provisions concerning pharmacy payments under the Medical Assistance Article of the Illinois Public Aid Code, provides that the Department of Healthcare and Family Services may reimburse a pharmacy owned by an entity participating in the federal Drug Pricing Program under the federal Public Health Service Act, for drugs purchased under the Program, an amount equal to or greater than the ceiling price calculated under the federal Act. Provides that all Medicaid managed care organizations must reimburse a pharmacy participating in the federal Drug Pricing Program, for drugs purchased under the Program, an amount equal to or greater than the current national average drug acquisition cost listing for the pharmaceutical product. Provides that the Department, a Medicaid managed care organization, and a pharmacy benefit manager under contract with a Medicaid managed care provider to reimburse pharmacy providers shall not prohibit any entity or pharmacy participating in the federal Drug Pricing Program from using drugs purchased under the federal Act when submitting claims for pharmaceutical reimbursement. Makes other changes.

Bill Text

Amendments

3 amendments

Click Show changes on an amendment above to see how it modifies the bill.

Action History

  1. Session Sine Die

  2. Senate Committee Amendment No. 3 Rule 3-9(a) / Re-referred to Assignments

  3. Rule 3-9(a) / Re-referred to Assignments

  4. Senate Committee Amendment No. 3 Assignments Refers to Insurance

  5. Senate Committee Amendment No. 3 Referred to Assignments

  6. Senate Committee Amendment No. 3 Filed with Secretary by Sen. David Koehler

  7. Postponed - Insurance

  8. Re-assigned to Insurance

  9. Rule 3-9(a) / Re-referred to Assignments

  10. Sponsor Removed Sen. Chapin Rose

  11. Re-assigned to Insurance

  12. Rule 2-10 Committee/3rd Reading Deadline Established As May 21, 2021

  13. Senate Committee Amendment No. 2 Rule 3-9(a) / Re-referred to Assignments

  14. Rule 3-9(a) / Re-referred to Assignments

  15. Rule 2-10 Committee/3rd Reading Deadline Established As May 7, 2021

  16. Added as Co-Sponsor Sen. Terri Bryant

  17. Rule 2-10 Committee/3rd Reading Deadline Established As April 30, 2021

  18. Postponed - Insurance

  19. Senate Committee Amendment No. 1 Adopted

  20. Senate Committee Amendment No. 2 Assignments Refers to Insurance

  21. Rule 2-10 Committee Deadline Established As April 23, 2021

  22. Senate Committee Amendment No. 2 Referred to Assignments

  23. Senate Committee Amendment No. 2 Filed with Secretary by Sen. David Koehler

  24. Added as Co-Sponsor Sen. Steven M. Landek

  25. Postponed - Insurance

  26. Senate Committee Amendment No. 1 Postponed - Insurance

  27. Added as Co-Sponsor Sen. Julie A. Morrison

  28. Sponsor Removed Sen. Antonio Muñoz

  29. Senate Committee Amendment No. 1 Assignments Refers to Insurance

  30. Added as Co-Sponsor Sen. Melinda Bush

  31. Added as Chief Co-Sponsor Sen. Michael E. Hastings

  32. Senate Committee Amendment No. 1 Referred to Assignments

  33. Senate Committee Amendment No. 1 Filed with Secretary by Sen. David Koehler

  34. Added as Co-Sponsor Sen. Chapin Rose

  35. Added as Co-Sponsor Sen. Laura Fine

  36. Postponed - Insurance

  37. Added as Co-Sponsor Sen. Darren Bailey

  38. Added as Chief Co-Sponsor Sen. Napoleon Harris, III

  39. Added as Co-Sponsor Sen. Doris Turner

  40. Added as Co-Sponsor Sen. Dale Fowler

  41. Added as Co-Sponsor Sen. Steve McClure

  42. Assigned to Insurance

  43. Added as Co-Sponsor Sen. Sally J. Turner

  44. Added as Co-Sponsor Sen. Mattie Hunter

  45. Added as Co-Sponsor Sen. Antonio Muñoz

  46. Added as Co-Sponsor Sen. Cristina Castro

  47. Added as Co-Sponsor Sen. Sara Feigenholtz

  48. Added as Chief Co-Sponsor Sen. Laura M. Murphy

  49. Added as Chief Co-Sponsor Sen. Linda Holmes

  50. Referred to Assignments

  51. First Reading

  52. Filed with Secretary by Sen. David Koehler

Sponsors

Sponsorship breakdown

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1 sponsors · 17 co-sponsors · 165 not signed on

Sponsors (1)

Co-sponsors (17)

Not signed on (165)

165 members have not signed on to this bill.

Show all 165 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 2008 do?
Amends the Illinois Insurance Code. Provides that if a generic equivalent for a brand name drug is approved by the federal Food and Drug Administration, plans that provide coverage for prescription drugs through the use of a drug formulary that are amended, delivered, issued, or renewed in the State on or after January 1, 2022 shall comply with specified requirements. Provides that the Department of Insurance may adopt rules to implement provisions concerning notice of change of drug formulary. In provisions concerning a contract between a health insurer and a pharmacy benefit manager, provides that a pharmacy benefit manager must update and publish maximum allowable cost pricing information according to specified requirements, must provide a reasonable administrative appeal procedure to allow pharmacies to challenge maximum allowable costs, and must comply with specified requirements if an appeal is denied. Sets forth provisions concerning pharmacy benefit manager contracts; specified requirements that a pharmacy benefit manager shall comply with; specified requirements that an auditing entity shall comply with when conducting a pharmacy audit; and specified requirements concerning pharmacy network access standards. Provides that a violation of specified provisions is an unfair method of competition and unfair and deceptive act or practice in the business of insurance. Sets forth provisions concerning applicability of the Pharmacy Benefit Managers Article of the Illinois Insurance Code, and provisions concerning fiduciary responsibility of a pharmacy benefit manager. Defines terms. Makes other changes. Amends the Illinois Public Aid Code. Sets forth provisions concerning reimbursement of professional dispensing fees and acquisition costs for pharmacy providers. Senate Committee Amendment No. 1 Adds reference to: 215 ILCS 5/513b7 new 215 ILCS 5/513b8 new 215 ILCS 124/35 new Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Provides that a pharmacy may not be subject to a chargeback or recoupment for a clerical or recordkeeping error in a required document or record unless the pharmacy benefit manager can provide proof of intent to commit fraud or such error results in actual financial harm to the pharmacy benefit manager, a health plan managed by the pharmacy benefit manager, or a consumer. Removes various provisions concerning pharmacy benefit manager contracts. Defines "spread pricing". Removes various definitions. Amends the Network Adequacy and Transparency Act. In provisions concerning pharmacy payments under the Medical Assistance Article of the Illinois Public Aid Code, provides that the Department of Healthcare and Family Services may reimburse a pharmacy owned by an entity participating in the federal Drug Pricing Program under the federal Public Health Service Act, for drugs purchased under the Program, an amount equal to or greater than the ceiling price calculated under the federal Act. Provides that all Medicaid managed care organizations must reimburse a pharmacy participating in the federal Drug Pricing Program, for drugs purchased under the Program, an amount equal to or greater than the current national average drug acquisition cost listing for the pharmaceutical product. Provides that the Department, a Medicaid managed care organization, and a pharmacy benefit manager under contract with a Medicaid managed care provider to reimburse pharmacy providers shall not prohibit any entity or pharmacy participating in the federal Drug Pricing Program from using drugs purchased under the federal Act when submitting claims for pharmaceutical reimbursement. Makes other changes.
Who sponsors SB 2008?
SB 2008 is sponsored by David Koehler (Democrat), Linda Holmes (Democrat), Laura M. Murphy (Democrat), Napoleon Harris III (Democrat), Michael E. Hastings (Democrat), Sara Feigenholtz (Democrat), Cristina Castro (Democrat), Mattie Hunter (Democrat), Sally J. Turner (Republican), Steve McClure (Republican), Doris Turner (Democrat), Darren Bailey, Laura Fine (Democrat), Melinda Bush, Julie A. Morrison (Democrat), Steven M. Landek, Terri Bryant (Republican), and Dale Fowler (Republican).
What is the current status of SB 2008?
This bill died with 102nd Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 2008?
Track SB 2008 free on One Click Politics — get push/email alerts when it moves.

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