Healthcare (Prescription Drugs)

Amends the Illinois Insurance Code. In provisions concerning pharmacy benefit manager contracts, provides that a pharmacy benefit manager must not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee of $10.49. Provides that, if the national average drug acquisition cost is not available at the time a drug is administered or dispensed, a pharmacy benefit manager may not reimburse in an amount that is less than the wholesale acquisition cost of the drug, plus a professional dispensing fee of $10.49.

Amends the Illinois Insurance Code. Sets forth provisions requiring an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after the effective date of the amendatory Act to provide coverage for up to a 12-month supply of prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within the provider's scope of practice and dispensed at one time for an enrollee by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides that, notwithstanding any other provision of law, a dispensing provider or pharmacist shall dispense, at a patient's request, up to a 12-month supply of a prescription hormone therapy and the necessary supplies for self-administration pursuant to a valid prescription that specifies an initial quantity followed by periodic refills, except as specified. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under the provisions of those Acts.

Creates the 340B Integrity Act. Defines terms. Provides that, beginning January 1, 2027, 340B covered entities shall not bill any medical assistance fee-for-service or medical assistance managed care programs under the Illinois Public Aid Code for 340B drugs. Provides that, beginning July 1, 2026 a 340B covered entity shall use 80% of 340B profits from the prior year to decrease at the point of sale, including at the 340B contract pharmacy, the out-of-pocket costs paid for 340B drugs that are dispensed or administered to low-income patients of the 340B covered entity. Provides that, on or before September 1, 2026, and on or before September 1 of each year thereafter, each 340B covered entity shall annually report to the Department of Insurance, with respect to the 340B covered entity and separately for each offsite outpatient facility associated with the 340B covered entity, the specified information about the prior year. Provides that, on or before December 31, 2026, the Department of Central Management Services shall submit a report to the General Assembly on any impact to the State employee health plan arising from 340B covered entity purchases, 340B contract pharmacy arrangements, and general practices related to 340B drugs, regardless of whether the 340B drugs were self-administered or provider-administered. Provides that the report shall include, but not be limited to, an analysis of foregone rebates, the impact on premiums, and the impact to State employee out-of-pocket costs. Provides that, on or before December 31, 2026, the Department of Healthcare and Family Services shall report to the General Assembly on certain items for total aggregated covered outpatient drug units dispensed or administered in the State for the prior calendar year in connection with the medical assistance program under the Illinois Public Aid Code, broken out by fee-for-service and by each managed care plan. Makes other changes. Effective immediately.

Amends the Pharmacy Practice Act. Defines "large pharmacy chain" and "retail pharmacy". Provides that a large pharmacy chain operating in the State shall ensure that each of the large pharmacy chain's retail pharmacy locations maintains, at minimum, an inventory that is sufficient to cover the needs of existing patients for up to 14 days without needing to restock. Requires each retail pharmacy location to implement a predictive restocking practice to prevent or mitigate future inventory shortages. Provides that, if a patient attempts to fill a prescription that a retail pharmacy location does not have in stock, the retail pharmacy location shall provide timely mail-order fulfillment, up to and including overnight shipping, if necessary to provide a medication approved by the United States Food and Drug Administration in time to ensure no missed doses.

Creates the Illinois Affordable Drug Manufacturing Act. Provides that the Department of Human Services shall enter into partnerships with drug companies or manufactures to: (i) increase competition, lower prices, and address shortages in the market for generic prescription drugs; (ii) reduce the cost of prescription drugs for public and private purchasers, taxpayers, and consumers; and (iii) increase patient access to affordable drugs. Provides that such partnerships shall be made with the intent to ensure the wide availability of generic prescription drugs to public and private purchasers, providers and suppliers, and pharmacies as appropriate. Requires that such drugs must be produced or distributed by a drug company or generic drug manufacturer that is registered with the United States Food and Drug Administration. Sets forth price setting criteria and a list of the most common generic prescription drugs that are to be produced and distributed through the partnerships. Requires the Department to consult with other State agencies, licensed health care service plans, health insurers, hospitals, and pharmacy benefit managers in maintaining the list of generic prescription drugs. Contains provisions concerning minimum drug procurement thresholds; reporting requirements; and other matters. Makes implementation of the Act subject to appropriation. Effective immediately, except that certain provisions take effect on January 1, 2029.

Amends the Pharmacy Practice Act. In provisions exempting the practice of specified professionals and their prescribing of such drugs, medicines, or poisons as may seem appropriate to the professionals, provides that this exemption is without regard to whether such drugs, medicines, or poisons are not typically prescribed by such licensed individuals or by licensed individuals in a same or similar specialty or are self-prescribed, with the exception of controlled substances. Provides that a licensee does not act in good faith when the licensee refuses to compound, fill, or dispense prescriptions of physicians licensed to practice medicine in all its branches solely because the prescriptions are not typically issued by that physician or by physicians in the same or similar specialty or are self-prescribed, with the exception of controlled substances. Provides that it is a violation of specified provisions for any prescriber or dispenser to adopt a contrary policy. Effective immediately.

Amends the Pharmacy Practice Act. Defines "retail pharmacy". Provides that a retail pharmacy that, on average, receives 150 or more prescription drug orders during its operating hours must satisfy one of the following requirements during all times that the pharmacy remains open for the transaction of business: (1) a pharmacist is present at the location and working in his or her capacity as a pharmacist, or (2) a registered pharmacy technician, registered certified pharmacy technician, student pharmacist, or other supportive staff that is authorized to sell prescriptions is present at the location and working in that capacity pursuant to provisions concerning pharmacy working conditions.

Amends the Pharmacy Benefit Manager Article of the Illinois Insurance Code. Provides that a covered individual's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80% of all rebates received, or to be received, or to be received, in connection with the dispensing or administration of the prescription drug. Provides that a health insurer or its agents shall not publish or otherwise reveal information regarding the actual amount of rebates a health insurer receives on a product or therapeutic class of products, manufacturer-specific basis, or pharmacy-specific basis and that the information is confidential. Defines terms. Amends the Freedom of Information Act to make a conforming change. Amends the Pharmacy Practice Act. Provides that a pharmacist may substitute a biological product (instead of an interchangeable biological product) if, among other requirements, the product being considered for substitution is either the reference product or a product approved by the United States Food and Drug Administration as a biosimilar of the prescribed biological product (instead of if the substituted product has been determined by the United States Food and Drug Administration to be interchangeable with the prescribed biological product). Makes conforming changes.

Creates the Canadian Prescription Drug Importation Act. Provides that the Department of Public Health shall establish the Canadian prescription drug importation program for the importation of safe and effective prescription drugs from Canada which have the highest potential for cost savings to the State. Provides that the Department shall contract with a vendor to provide services under the program. Provides that by December 1, 2026 and each year thereafter, the vendor shall develop a wholesale prescription drug importation list identifying the prescription drugs that have the highest potential for cost savings to the State. Provides that the vendor shall identify Canadian suppliers that are in full compliance with the provisions of the Act and contract with the Canadian suppliers to import drugs under the program. Provides for: a bond requirement; requirements for eligible prescription drugs; requirements for eligible Canadian suppliers; requirements for eligible importers; distribution requirements; federal approval; prescription drug supply chain documentation; immediate suspension of specified imported drug; requirements of an annual report; notification of federal approval. Provides that the Department shall adopt rules necessary to implement the Act. Effective immediately.

Creates the Wholesale Prescription Drug Importation Program Act. Requires the Department of Public Health to establish the Wholesale Prescription Drug Importation Program. Provides that the Department shall implement the program by: (1) contracting with one or more prescription drug wholesalers and Canadian suppliers to import prescription drugs and provide prescription drug cost savings to consumers in this State; (2) developing a registration process for health benefit plan issuers, health care providers, and pharmacies to obtain and dispense prescription drugs imported under the program; (3) developing a list of prescription drugs, including the prices of those drugs, that meet certain requirements set forth under the Act and publishing the list on the Department's website; (4) establishing an outreach and marketing plan to generate program awareness; (5) ensuring the program and the prescription drug wholesalers that contract with this State comply with certain federal tracking, tracing, verification, and identification requirements; and other matters. Sets forth eligibility criteria for prescription drugs that may be imported into the State under the program. Contains provisions concerning program expansion; program funding; audit procedures; annual reporting requirements; the adoption of rules to implement the Act; and federal waiver or authorization requirements. Effective July 1, 2025.