Governor J.B. Pritzker signed HB 465 regulating Pharmacy Benefit Managers (PBMs), which are businesses that negotiate prices between drug manufacturers and pharmacies on behalf of insurance companies.
Falling under the Illinois Department of Insurance, the new PBM regulations take several steps to increase access to health care and protect patients:
- Requires insurers to apply third-party payments, discounts, vouchers and co-pay cards to a deductible, the co-pay or out-of-pocket maximum associated with health insurance
- Prevents gag clauses which limit pharmacists from advising patients when lower-cost alternatives may be available or when paying cash is cheaper than using insurance
- Protects consumers entering the emergency room from being denied coverage, even if their ailment turns out to be a non-emergency
- Provides more transparency in the pricing and reimbursement models PBM utilize by requiring HFS to approval contracts that impact Medicaid
Ben Calcaterra with the Illinois Pharmacists Association says the bill will help keep independent pharmacies open as well. “The PBMs right now are able to set prices well below what pharmacies are able to buy their drugs for and this will give some safeguards so pharmacies will stop closing their doors across the state,” Calcaterra said.