IL SB3642

Excludes pharmacy benefits managers from the Third Party Prescription Program Act and creates a new Article XXXIIB to regulate pharmacy benefits managers operating in Illinois.

Requires all pharmacy benefits managers doing business in the State to register annually with the Director of Insurance and establishes grounds for suspension, revocation, or denial of registration including deceptive practices and nonpayment of fees.

Mandates pharmacy benefits managers maintain multi-source generic drug lists with uniform pricing across all contracted pharmacies, updated at least every 5 business days, and establish independent third-party appeals processes for pricing disputes with 7-day resolution timelines.

Prohibits pharmacy benefits managers from charging State pharmacies higher reimbursement rates or fees than pharmacy benefits manager affiliates or out-of-state mail order pharmacies, and restricts contract provisions that penalize patients for using retail pharmacies over mail order services.

Establishes strict audit standards limiting on-site audits to 250 unique prescriptions per 12-month period, requiring 15 days advance notice, prohibiting audits beyond 24 months after claim adjudication, and allowing pharmacies to appeal audit findings with Director review available within 30 days.