SB1971 Summary

• Establishes requirements for pharmacy benefits managers (PBMs) creating maximum allowable cost (MAC) lists for drug reimbursement, including that drugs must be therapeutically equivalent, available from national/regional wholesalers in Illinois, and not obsolete.

• Requires PBMs to provide pharmacies access to MAC lists, update them within 7 calendar days of a 10% or greater pharmacy acquisition cost increase or 60% or more wholesaler price changes, and notify pharmacies of updates.

• Mandates PBMs establish reasonable administrative appeal procedures allowing pharmacies to challenge MAC costs within 7 business days and respond to appeals within 7 business days with options to adjust costs, permit rebilling, or provide alternative wholesaler information.

• Prohibits PBMs from reimbursing pharmacies in Illinois at rates lower than affiliated pharmacies for identical services and allows pharmacies to decline services if reimbursement falls below their acquisition cost.

• Classifies violations of these PBM requirements as deceptive trade practices under the Uniform Deceptive Trade Practices Act.