Signed by Governor JB Pritzker

Vote Smart's Synopsis:

Vote to amend and pass a bill that prohibits spread pricing and patient steering in Illinois.

Highlights:

• Establishes the Prescription Drug Affordability Act, which imposes several transparency provisions on pharmacy benefit managers (PBMs) (Sec. 1-98).

• Prohibits patient “steering” and “spread pricing” (Sec. 1-98).

• Defines “steering” as the following, including, but not limited to (Sec. 1-98):

• Requiring a covered individual to only use a pharmacy, including a mail-order or specialty pharmacy, in which the pharmacy benefit manager or its affiliate maintains an ownership interest or control;

• Offering or implementing a plan design that encourages a covered individual to only use a pharmacy in which the pharmacy benefit manager or an affiliate maintains an ownership interest or control, if the plan design increases costs for the covered individual. This includes a plan design that requires a covered individual to pay higher costs or an increased share of costs for a drug or drug-related service if the covered individual uses a pharmacy that is not owned or controlled by the pharmacy benefit manager or its affiliate; or

• Reimbursing a pharmacy or pharmacist for a drug and pharmacist service in an amount less than the amount that the pharmacy benefit manager reimburses itself or an affiliate, including affiliated manufacturers or joint ventures for providing the same drug or service.

• Defines “spread pricing” as the model of drug pricing in which the pharmacy benefit manager charges a health benefit plan a contracted price for drugs, and the contracted price for the drugs differs from the amount the pharmacy benefit manager directly or indirectly pays the pharmacist or pharmacy for the drugs, pharmacist services, or drug and dispensing fees (Sec. 1-98).

• Establishes a grant program for pharmacies that meet specified criteria (Sec. 1-98).

• Specifies that the provisions of this bill shall take effect January 1, 2026 (Sec. 99).

Full Bill Text