Illinois Governor JB Pritzker signed legislation this week creating a regulatory framework for pharmacy benefit managers in the state. HB 465 goes into effect January 1, 2020, and hopes to protect patients and increase access by:
- Requiring insurers to apply third-party payments, discounts, vouchers and co-pay cards to a deductible, the co-pay, or out-of-pocket maximum
- Preventing gag clauses which limit pharmacists from advising patients when lower-cost alternatives may be available or when paying cash is cheaper than using insurance
- Protecting consumers entering the emergency room from being denied coverage
- Providing more transparency in the pricing and reimbursement models PBM utilize by requiring HFS to approval contracts that impact Medicaid
“The signing of HB 465 establishes foundational accountability and transparency for Pharmacy Benefit Managers and enables the Departments of Insurance and Healthcare Family Services to ensure that patients have access to their pharmacists and their local pharmacy in their community,” said Illinois Pharmacists Association Executive Director Garth K. Reynolds.