IL HB0465

Amends the Freedom of Information Act to add "pharmacy benefit managers" to the definition of entities subject to examination records exemptions under Section 7(t), allowing public bodies to withhold examination and condition reports related to pharmacy benefit managers from disclosure.

Creates a new Article XXXIIB in the Illinois Insurance Code establishing registration and licensure requirements for pharmacy benefit managers, effective July 1, 2020, including registration fees, examination authority, and enforcement provisions with fines up to $50,000 for violations.

Requires pharmacy benefit manager contracts to include maximum allowable cost pricing updates at least every 7 calendar days, pharmacy appeal processes for reimbursement disputes, and prohibits limiting pharmacist disclosures about cost-sharing that exceeds retail prices.

Adds requirements that health insurers and pharmacy benefit managers cannot charge patients more than the lesser of their cost-sharing amount or the retail price of a prescription drug, and requires disclosure of manufacturer payments for brand-name prescriptions once generics become available.

Authorizes the Illinois Department of Healthcare and Family Services to contract with third-party administrators for Medicaid pharmacy benefits and requires annual reporting on pharmacy contracts, formularies, and maximum allowable cost concerns to the General Assembly.