HB2919 Summary

• Amends Illinois Insurance Code Section 513b1 to require pharmacy benefit managers update maximum allowable cost pricing at least every 7 calendar days and maintain processes to eliminate outdated drugs from pricing lists.

• Grants plan sponsors an annual right to audit pharmacy benefit manager compliance with contract terms, including full disclosure of rebates and value from pharmaceutical manufacturers, including amounts provided to parent, subsidiary, or affiliate companies.

• Requires pharmacy benefit managers to disclose upon request the actual amounts paid to pharmacies and to notify contracting parties of any consideration received from manufacturers for brand-name prescriptions once generic or biologically similar products become available.

• Establishes appeal process for contracted pharmacies to challenge maximum allowable cost reimbursements within 14 calendar days, with pharmacy benefit managers required to respond within 14 days and provide reason for denial if appeal is denied.

• Voids any contract provision entered into, amended, or renewed after the effective date that contradicts these requirements; applies to contracts and insurance policies effective July 1, 2020 and later.