Illinois governor signs sweeping PBM legislation

NCPA August 26, 2019

Gov. J.B. Pritzker (D) has signed H.B. 465, creating the state's first comprehensive regulatory framework for PBMs. The law, which takes effect Jan. 1, 2020, will:

  • Require insurers to apply third-party payments, discounts, vouchers and copay cards to a deductible, the copay or out-of-pocket maximum associated with health insurance.

  • Prevent gag clauses which limit pharmacists from advising patients when lower-cost alternatives may be available or when paying cash is cheaper than using insurance.

  • Protect consumers entering the emergency room from being denied coverage, even if their ailment turns out to be a non-emergency.

  • Provide greater transparency in the pricing and reimbursement models PBMs use by requiring the state department of health and family services to approve contracts that affect Medicaid.