HB3607 Summary

• Amends Illinois Insurance Code to regulate pharmacy audits by establishing procedures for notice, scope, compensation, and audit report timelines for auditing entities.

• Prohibits use of extrapolation to calculate penalties or chargebacks unless required by federal law, and limits audits to maximum 250 prescriptions and 24-month lookback period.

• Requires all prescription drug coverage entities to permit prorated cost-sharing for prescriptions dispensed as less than 30-day supplies when indicated for patient benefit or medication synchronization.

• Prohibits denial of coverage for chronic illness drug dispensing made in accordance with a synchronization plan among patient, prescriber, and pharmacist, and requires dispensing fees be based on number of prescriptions, not days' supply.

• Establishes Department of Insurance enforcement authority with minimum financial penalties of $1,000 per violation, effective immediately.