Healthcare (Prescription Drugs)

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 Medical Assistance Article of the Illinois Public Aid Code. In provisions prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs on specified FDA-approved prescription drugs for mental illness, provides that the prohibition shall apply if a preferred or non-preferred drug is prescribed to an adult patient to treat a serious mental illness and during the preceding 60 days, the patient who experienced an inadequate response was prescribed and unsuccessfully treated with a 14-day treatment trial of a drug for the same clinical condition that is included on the preferred drug list. Removes provisions conditioning the receipt of prescription drugs without prior authorization on: (i) the patient changing providers while receiving a previously authorized prescription drug; (ii) the patient changing insurance coverage while receiving a previously authorized prescription drug; and (iii) the patient's prescription for a previously authorized drug modifies the dosage, dosage frequency, or both, of the drug as part of the same treatment for which the drug was previously prescribed.

Amends the Public Higher Education Act. Provides that, beginning with the 2025-2026 school year, each public institution of higher education with student health services shall provide enrolled students with access to health care professionals authorized under State law to prescribe contraception. Provides that, beginning with the 2025-2026 school year, if the public institution of higher education's student health services includes a pharmacy, the pharmacy on campus shall dispense contraception to enrolled students who wish to fill their prescriptions at the university pharmacy. Provides that, beginning with the 2025-2026 school year, each public institution of higher education with student health services shall provide enrolled students with access to health care professionals authorized under State law to prescribe medication abortion. Provides that a public institution of higher education that dispenses medication abortion from the university pharmacy shall enter into a referral agreement with a tertiary care facility with obstetrics and gynecological services in the event of complication from medication abortion or suspected complicated pregnancy prior to dispensing medication abortion. Requires each public institution of higher education to report annually to the Board of Higher Education that policies under the provisions have been adopted. Requires the Board to post to its website annually each public institution of higher education's compliance with the policies under the provisions. Effective immediately.

Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.

Creates the Nonopioid Alternatives for Pain Act. Allows the Department of Public Health to develop and publish on its website a nonopioid alternatives pamphlet, with certain requirements. 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.

Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.

Creates the 340B Grantee Contract Pharmacy Access Act. Provides that no person, including a pharmaceutical manufacturer, may deny, restrict, or otherwise limit the acquisition of a 340B drug by a 340B grantee or a 340B contract pharmacy authorized to receive 340B drugs on behalf of the 340B grantee unless the acquisition is prohibited by federal law. Provides that the Department of Financial and Professional Regulation is authorized to enforce the Act and investigate possible violations of the Act by any person, including a pharmaceutical manufacturer. Sets forth provisions concerning preemption. Effective immediately.

Creates the Illinois Medicare for All Health Care Act. Provides that all individuals residing in the State are covered under the Illinois Health Services Program for health insurance. Sets forth the health coverage benefits that participants are entitled to under the Program. Sets forth the qualification requirements for participating health providers. Sets forth standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the Program. Provides that investor-ownership of health delivery facilities is unlawful. Provides that the State shall establish the Illinois Health Services Trust to provide financing for the Program. Sets forth the requirements for claims billing under the Program. Provides that the Program shall include funding for long-term care services and mental health services. Provides that the Program shall establish a single prescription drug formulary and list of approved durable medical goods and supplies. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Sets forth provisions concerning patients' rights. Provides that the employees of the Program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective January 1, 2026.

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 Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions.