Healthcare (Prescription Drugs)

Creates the Patient Access to Pharmacy Protection Act. Defines terms. Provides that no person, including a pharmaceutical manufacturer, may deny, restrict, prohibit, condition, or otherwise interfere with, either directly or indirectly, the acquisition of a 340B drug by, or delivery of a 340B drug to, a 340B covered entity or a 340B contract pharmacy authorized to receive 340B drugs on behalf of the 340B covered entity unless such receipt is prohibited by federal law. Provides that no person, including a pharmaceutical manufacturer, may impose any restriction on the ability of a 340B covered entity to contract with or designate a 340B contract pharmacy including restrictions relating to the number, location, ownership, or type of 340B contract pharmacy. Provides that no person, including a pharmaceutical manufacturer, may require or compel a 340B covered entity or 340B contract pharmacy to submit or otherwise provide ingredient cost or pricing data pertinent to 340B drugs unless required by State or federal law; institute requirements in any way relating to how a 340B covered entity manages its inventory of 340B drugs that are not required by a State or federal agency, including requirements relating to the frequency or scope of audits of inventory management systems of a 340B covered entity or a 340B contract pharmacy; or submit data or information that is not required by State or federal law as a condition for a 340B covered entity, its 340B contract pharmacy, or a location otherwise authorized by a 340B covered entity to receive 340B drugs. Sets forth provisions concerning enforcement of this Act; preemption of this Act; and severability of this Act. Effective immediately.

Amends the Pharmacy Practice Act. Defines "first-choice pharmacy". Provides that, if a first-choice pharmacy is unable to fill or provide a patient with a prescription, the first-choice pharmacy may forward the prescription order to another pharmacy that is able to fill the prescription.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2026 that provides coverage for prescription drugs shall require 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 100% of all rebates received in connection with the dispensation or administration of the prescription drug. Provides that an insurer shall apply any rebate amount in excess of the defined cost sharing amount to the health plan to reduce premiums. Provides that the provisions shall not preclude an insurer from decreasing a covered individual's defined cost sharing by an amount greater than the stated amount at the point of sale. Provides that the Department of Insurance may adopt rules to implement the provisions.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Defines "pharmacy desert". Requires the Department of Public Health to provide an annual report to the General Assembly by December 31 of each year that identifies the locations of pharmacy deserts within the State and provides information about health issues associated with pharmacy deserts. Provides that if the annual report contains information from the federal government that identifies the locations of pharmacy deserts in the State and provides information on health issues associated with pharmacy deserts, then the requirements of the provisions shall be satisfied. Effective immediately.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Allows the Department of Public Health to develop and publish on its website a nonopioid alternatives pamphlet, with certain requirements. Amends the Illinois Insurance Code. Prohibits a health insurance issuer to deny coverage of a nonopioid prescription drug in favor of an opioid prescription drug. Amends the Illinois Public Aid Code. Provides that coverage shall not be denied for a nonopioid prescription drug in favor of an opioid prescription drug. Requires that nonopioid drugs preferred on a specific list for the treatment or management of pain shall not be disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain. Effective July 1, 2027.

Amends the Pharmacy Practice Act. Provides that "practice of pharmacy" includes the assessment and consultation of patients and dispensing of contraceptives, including emergency contraception (rather than the dispensation of hormonal contraceptives). In provisions concerning the dispensation of contraceptives, changes the contraceptives dispensed to contraceptives, including emergency contraception (rather than hormonal contraceptives). Makes conforming changes. Amends the Illinois Public Aid Code. Provides that the medical assistance program shall cover patient care services provided by a pharmacist for contraceptives, including emergency contraception (rather than hormonal contraceptives). Makes conforming changes.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to conduct a study on managed care pharmacy access standards. Provides that the study shall review the current access standards, with a focus on disproportionately impacted areas. Requires the Department to seek input from consumers of pharmacy services. Requires the Department to report its findings to the Governor and the General Assembly by January 1, 2026 and to publish the report on the Department's website. Provides that any retail pharmacy that is enrolled as an eligible retail pharmacy provider in the medical assistance program and is not sanctioned under investigation for fraud, waste, or abuse shall provide retail pharmacy services to any medical assistance recipient who resides in the same zip code as the pharmacy, regardless of whether the retail pharmacy is contracted to provide pharmacy services for the managed care organization that the recipient is enrolled with. Requires the managed care organization to pay the retail pharmacy the managed care organization's standard contractual rate. Effective immediately.

Amends the Illinois Insurance Code. Provides that any plan of health or accident insurance that provides coverage for prescription drugs and that is issued amended, renewed, or delivered on or after January 1, 2027 must include any amount paid by the insured or paid on behalf of the insured by another person when calculating the insured's overall contribution to any out-of-pocket maximum or other cost-sharing requirement. Provides an exception for a high-deductible health plan to the extent that providing coverage would disqualify that plan from eligibility for a health savings account.

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Provides that the Department of Public Health shall create a prescription drug discount card program in the State. Provides that the Department shall start the program as soon as reasonably practicable after the effective date of the amendatory Act. Provides that the Department shall adopt rules necessary to carry out the program.

Amends the Illinois Insurance Code. Provides that a group or individual plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 that provides coverage for prescription insulin drugs shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription weight loss drugs, such as Ozempic, Wegovy, and Moujaro, to an amount not to exceed $200, regardless of the quantity or type of covered prescription weight loss drug used to fill the insured's prescription. Provides that an insurer is not prohibited from reducing an insured's cost sharing by an amount greater than the specified amount. Grants the Department of Insurance rulemaking and enforcement authority. Provides that, on January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance 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 those provisions.