IL HB3630

Amends Illinois Insurance Code to regulate pharmacy benefit managers (PBMs) and drug formularies, effective for contracts issued or renewed on or after the bill's effective date.

Requires insurance companies with drug formularies to immediately substitute brand name drugs with FDA-approved generic equivalents or move brand drugs to lower cost-sharing tiers starting January 1, 2022.

Establishes comprehensive PBM contract requirements including: updating maximum allowable cost (MAC) pricing every 7 days, providing reasonable appeals for pharmacies to challenge MAC pricing, prohibiting certain fees, and ensuring reimbursement at or above national average drug acquisition cost.

Implements pharmacy audit standards limiting on-site audits to 100 randomly selected prescriptions per 12-month period with 30-day advance notice, restricting audit lookback to 24 months, and prohibiting extrapolation for calculating penalties except as required by federal law.

Amends Illinois Public Aid Code to require Medicaid managed care organizations and PBMs to reimburse pharmacies at rates no less than the fee-for-service program's professional dispensing fees and acquisition costs.