INS-PHARMACY BENEFIT MANAGERS Senate SponsorsSen. David Koehler-Linda Holmes-Laura M. Murphy, Sara Feigenholtz, Cristina Castro, Mattie Hunter, Sally J. Turner, Steve McClure, Dale Fowler, Doris Turner-Napoleon Harris, III, Darren Bailey, Laura Fine-Michael E. Hastings, Melinda Bush, Julie A. Morrison, Steven M. Landek and Terri Bryant 1/10/2023SenateSession Sine Die 215 ILCS 5/155.37215 ILCS 5/424from Ch. 73, par. 1031215 ILCS 5/513b1215 ILCS 5/513b1.1 new215 ILCS 5/513b1.3 new305 ILCS 5/5-5.12from Ch. 23, par. 5-5.12305 ILCS 5/5-36Amends 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 new215 ILCS 5/513b8 new215 ILCS 124/35 newReplaces 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. 2/26/2021SenateFiled with Secretary by Sen. David Koehler 2/26/2021SenateFirst Reading 2/26/2021SenateReferred to Assignments 3/5/2021SenateAdded as Chief Co-Sponsor Sen. Linda Holmes 3/5/2021SenateAdded as Chief Co-Sponsor Sen. Laura M. Murphy 3/5/2021SenateAdded as Co-Sponsor Sen. Sara Feigenholtz 3/9/2021SenateAdded as Co-Sponsor Sen. Cristina Castro 3/9/2021SenateAdded as Co-Sponsor Sen. Antonio Muņoz 3/9/2021SenateAdded as Co-Sponsor Sen. Mattie Hunter 3/16/2021SenateAdded as Co-Sponsor Sen. Sally J. Turner 3/16/2021SenateAssigned to Insurance 3/16/2021SenateAdded as Co-Sponsor Sen. Steve McClure 3/17/2021SenateAdded as Co-Sponsor Sen. Dale Fowler 3/18/2021SenateAdded as Co-Sponsor Sen. Doris Turner 3/18/2021SenateAdded as Chief Co-Sponsor Sen. Napoleon Harris, III 3/23/2021SenateAdded as Co-Sponsor Sen. Darren Bailey 3/24/2021SenatePostponed - Insurance 3/25/2021SenateAdded as Co-Sponsor Sen. Laura Fine 4/7/2021SenateAdded as Co-Sponsor Sen. Chapin Rose 4/12/2021SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. David Koehler 4/12/2021SenateSenate Committee Amendment No. 1 Referred to Assignments 4/13/2021SenateAdded as Chief Co-Sponsor Sen. Michael E. Hastings 4/13/2021SenateAdded as Co-Sponsor Sen. Melinda Bush 4/14/2021SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance 4/14/2021SenateSponsor Removed Sen. Antonio Muņoz 4/14/2021SenateAdded as Co-Sponsor Sen. Julie A. Morrison 4/14/2021SenateSenate Committee Amendment No. 1 Postponed - Insurance 4/15/2021SenatePostponed - Insurance 4/15/2021SenateAdded as Co-Sponsor Sen. Steven M. Landek 4/16/2021SenateSenate Committee Amendment No. 2 Filed with Secretary by Sen. David Koehler 4/16/2021SenateSenate Committee Amendment No. 2 Referred to Assignments 4/16/2021SenateRule 2-10 Committee Deadline Established As April 23, 2021 4/20/2021SenateSenate Committee Amendment No. 2 Assignments Refers to Insurance 4/21/2021SenateSenate Committee Amendment No. 1 Adopted 4/21/2021SenatePostponed - Insurance 4/23/2021SenateRule 2-10 Committee/3rd Reading Deadline Established As April 30, 2021 4/29/2021SenateAdded as Co-Sponsor Sen. Terri Bryant 4/30/2021SenateRule 2-10 Committee/3rd Reading Deadline Established As May 7, 2021 5/7/2021SenateRule 3-9(a) / Re-referred to Assignments 5/7/2021SenateSenate Committee Amendment No. 2 Rule 3-9(a) / Re-referred to Assignments 5/10/2021SenateRule 2-10 Committee/3rd Reading Deadline Established As May 21, 2021 5/10/2021SenateRe-assigned to Insurance 5/12/2021SenateSponsor Removed Sen. Chapin Rose 5/21/2021SenateRule 3-9(a) / Re-referred to Assignments 1/5/2022SenateRe-assigned to Insurance 1/12/2022SenatePostponed - Insurance 2/1/2022SenateSenate Committee Amendment No. 3 Filed with Secretary by Sen. David Koehler 2/1/2022SenateSenate Committee Amendment No. 3 Referred to Assignments 2/8/2022SenateSenate Committee Amendment No. 3 Assignments Refers to Insurance 2/10/2022SenateRule 3-9(a) / Re-referred to Assignments 2/10/2022SenateSenate Committee Amendment No. 3 Rule 3-9(a) / Re-referred to Assignments 1/10/2023SenateSession Sine Die