Illinois governor signs sweeping PBM legislation

by NCPA | Aug 27, 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.