IL SB2515

Requires all pharmacy benefits managers (PBMs) operating in Illinois to register annually with the Department of Insurance and obtain a certificate of registration, with the Director having authority to revoke, suspend, deny, or restrict certificates for violations.

Establishes comprehensive pricing regulations including maximum allowable cost (MAC) pricing requirements with at least twice-monthly updates, appeals processes for pharmacy providers to contest MAC rates, and prohibition on transaction fees for electronic claims submissions.

Prohibits PBMs from mandating use of specific pharmacies or providing incentives limited to PBM-owned pharmacies, requires adequate network coverage (90% of beneficiaries within 2-5 miles in urban/suburban areas, 70% within 15 miles in rural areas), and prevents automatic enrollment or disenrollment without written agreement.

Sets detailed standards for on-site pharmacy audits including 30-day advance notice, 4-hour maximum duration, limitation to 100 prescriptions per initial audit, and prohibition on using extrapolation for calculating recoupments; requires written appeals process with final reports within 45-60 days.

Requires health plans to permit 90-day prescription supplies at any network community pharmacy without additional cost-sharing, allows medication synchronization with prorated daily cost-sharing, and prohibits PBMs from sharing patient data with PBM-owned pharmacies without explicit written consent; effective January 1, 2017.