Illinois lawmakers’ effort to reign in pharmacy benefit managers, the Prescription Drug Affordability Act, passed both houses of the General Assembly on the last day of the legislative session May 31.

The act targets the health insurance middlemen that manage members’ prescription drug benefits on behalf of the plans, negotiating prices with drug manufacturers, setting reimbursement rates for pharmacies, creating in-network lists for plan members to get prescriptions filled and creating formularies, or “preferred drug lists.”

The Illinois law, modeled after provisions being debated or passed by other states, forbids PBMs from engaging in spread pricing, charging insurance plans more than they reimburse pharmacies for, and keeping the difference; steering individuals to specific pharmacies or pharmacy companies; and limiting access to a covered drug by designating it a specialty drug contrary to the specified definition.

In addition, the law levies a fee, per each covered member, on PBMs that will be used in a fund award up to $25 million a year in grants to independent pharmacies and pharmacies located in rural counties, medically underserved areas, low-income communities and pharmacies that serve high concentrations of Medicaid patients.

“This really restricts the ability of PBMs to extract large amounts of money out of the prescription drug system,” state Sen. Dave Koehler, D-Peoria, the bill’s chief Senate sponsor, told Capitol News Illinois.

PBM advocates and the Illinois Chamber of Commerce warned the law will drive up drug costs.

"The legislation will increase prescription drug costs for every Illinois patient," said Sean Stephenson, senior director of state affairs for the Pharmaceutical Care Management Association. "It’s very disappointing Illinois lawmakers think this a good bill."

Lou Sandoval, president and CEO of Illinois Chamber of Commerce, said in an emailed statement on May 30 that the act "will drive up the cost of health plans for Illinois businesses with a $15/person fee applied to company-provided health plans in the state. In addition, there are other measures in the bill that have potential to increase the cost of employer-sponsored health insurance. The Illinois Chamber opposes passage of HB 1697 as part of its efforts to balance high quality benefits for Illinois employees and their families with affordability and transparency for Illinois employers."

340B, Medicaid and more

Koehler also hailed the passage of the Patient Access to Pharmacy Protection Act, aimed at protecting pharmacies engaged in the federal 340B prescription drug program.

“Health care should be accessible to all, and Illinois is taking the correct steps to make health care more affordable. These investments have the chance to help shape the health and well-being of families,” Koehler said in a statement. “By supporting critical access to places like safety-net hospitals, local clinics, and community pharmacies, we are one step closer to making sure that no resident of Illinois is left behind.”

The 340B measure would stop drugmakers from cutting off steep drug discounts to some pharmacies that contract with providers.

The federal 340B program mandates pharmaceutical makers provide deep discounts to drugs for Federally Qualified Health Centers and safety-net hospitals

In recent years, drugmakers have pushed back on ballooning use of the drug discounts by health systems and contract pharmacies by restricting 340B discounts on prescriptions filled by contract pharmacies. The Illinois bill intervenes in the federal program by requiring pharmaceutical manufacturers to distribute the discounted drugs to pharmacies that contract with 340B-covered providers.

The omnibus Medicaid bill, which often includes sweeping increases to the state’s Medicaid funding, turned out to be one of the most trimmed-down packages in recent memory, in light of uncertainty about how much federal money would come from, or be cut by, the Trump administration in its own federal budget.

“There were many, many, very worthy program expansions, rate increases that we considered during this process that we were unable to include because of the uncertainty in Washington,” Rep. Anna Moeller, D-Elgin, the current chair of the Medicaid Working Group, said on the House floor, according to Capitol News Illinois. 

As expected, the legislature voted to cancel a Medicaid-like program for undocumented immigrants age 42-64. The state’s Health Benefits for Immigrant Seniors, however, was provided $110 million in state funds for the next year for health coverage to immigrant seniors age 65 and over.

A provision which Moeller said would "fix" Medicaid program to ensure coverage of noncitizens who meet the income requirements for Medicaid and have pending applications for asylum in the United States, or for special visas as victims of trafficking, torture or other serious crimes, Capitol News Illinois reported.

One bill that failed to pass by the end of the General Assembly’s session was the hotly contested End-of-Life Options for Terminally Ill Patients Act. The bill would have allowed a qualified patient with a terminal disease to request that a physician prescribe aid-in-dying medication that would allow the patient to end the patient’s life in a peaceful manner.

Other health-related provisions passed by the general assembly include:

• A 75-cent raise for the Illinois Department on Aging’s Community Care Program home care workers, which was praised by SEIU Healthcare Illinois.

"Wage increases for home care workers will help more workers stay in the field, in turn allowing more Illinois seniors to age with dignity in their homes," according to a statement from the union. "That state lawmakers prioritized an increase when facing a significant budget shortfall–and elected to adopt several progressive revenue measures as well–shows a laudable commitment to protecting seniors."

• Legislation to improve medical forensic services for sexual assault survivors, which increases training opportunities for sexual assault nurse examiners and sexual assault forensic examiners, clarifies issues of enforcement by the state and requirements for treating hospitals and increases survivor access to follow-up care.

“Survivors deserve compassionate care that meets them where they’re at and puts their needs at the forefront,” Sen. Julie Morrison, D-Deerfeild, who sponsored the bill, said in a statement. “This legislation is a necessary response to gaps in the state’s sexual assault survivor law that have left too many victims without access to the critical and timely services they need.”

• An increase in both funding for the state tobacco control program and the cost of tobacco products, including e-cigarettes. The American Lung Association — Illinois praised a bill which equalizes taxes on e-cigarettes with the tax on other tobacco product, and raises the tax on both as well as a measure in the FY26 state budget that includes $5 million in new funding for tobacco prevention and education programs.