In Review: The PBM bill, HB 1697, jumped through the myriad hurdles of the legislative process within three days to become law. The Governor is expected to sign the bill soon. Provisions in the bill include:
- Applies to ERISA plans, exemption for Taft-Hartley plans
- Bans spread-price
- Prohibits pharmacy networks with only affiliated pharmacies, including mail order and specialty pharmacies
- Prohibits pharmacy networks that only provide patient incentives at affiliated pharmacies
- Requires PBMs to reimburse pharmacies for drugs at least the same amount as reimbursements to affiliated pharmacies
- Requires 100% of rebates received by the PBM or rebate aggregator to be passed through to plan sponsors, employers, or covered individuals
- Requires PBMs to allow any pharmacy to dispense specialty drugs as narrowly defined in the bill; imposes an annual $15 fee on every covered individual, of which $25 million will be used for a grant program to promote access to pharmacies administered by the Illinois Retail Merchant Association
In addition, the bill requires PBMs to disclose records of rebates annually to the Department. Provisions include:
- PBMs to submit reports annually to the Department, including data on drug claims, rebates, drug spending, pharmacy reimbursements, and more
- Requires PBMs to create summary documents of aggregated information to covered individuals
- Allows the Department to share data with an Illinois university to create an annual Pharmacist Dispensing Fee Cost Study
- Sets fines for failure to submit required information up to $10,000 per day per offense
- Requires the Department to conduct market conduct examinations of the three largest PBMs at least once every five years
Up Next: The Governor’s office publicly committed to a trailer bill during the fall Veto Session to address concerns about the grant administration. PCMA has asked the Department of Insurance to be available to meet with members to discuss implementation and compliance with the new law.
If you have any questions, please contact Sean Stephenson at sstephenson@pcmanet.org.
