After working closely with the Illinois Pharmacists Association and other Illinois pharmacy groups, IPC has seen success in Illinois with Governor JP. Pritzker signing into state law the "Prescription Drug Affordability & Accessibility Act" (HB 465). (see Governor Pritzker's press release here).
This new PBM state law, sponsored by Sen. Andy Manar and the IL House Majority Leader Greg Harris provides the first important state regulation over PBM activities through:
• PBM Registration - Currently, PBMs are not registered by the Department of Insurance and hinders proper state regulatory oversight and accountability.
• Pharmacy Gag Clause Bans - Gag Clauses prevent pharmacists from advising patients about low-cost alternatives, including paying the full cash price (which may be cheaper than utilizing the PBM and paying the copay).
• Pricing Transparency - PBMs utilize outdated and predatory pricing and reimbursement models - often at below acquisition costs - that undermine a pharmacies ability to maintain a sustainable practice.
• Data Transparency - Several states are concerned that PBMs are not providing complete and transparent information to government entities. Some states, including Kentucky have passed data transparency requirements for their Medicaid Managed Care program. These drug price transparency provisions require the same disclosure by PBMs to Illinois Medicaid.
HB 465 will help regulate PBM activities in Illinois' commercial insurance market and will provide tools for Illinois Medicaid to obtain pricing PBM use for MCO claims.
Please email Governor Pritzker through Governor Pritzker's Contact Page and thank him for signing this needed protection for pharmacy patients and their local pharmacies into law. This bill passed the Illinois Legislature unanimously, so email your local State Senator and State House Representative and thank them for passing this needed PBM regulation state law. If they represent you, give a special thanks Sen. Manar and Rep. Harris for their leadership and support for community pharmacy.
IPC will be working closely with IPA and other Illinois pharmacy group stakeholders to ensure that the Illinois Insurance Department and the Illinois Medicaid program develop regulations to properly enforce the "Prescription Drug Affordability & Accessibility Act" to ensure an end to PBM abuses that harm pharmacies and their patients in Illinois.