HB4862 Summary

• Requires pharmacy benefit managers and health benefit plan issuers to provide enrollees and prescribing providers with patient-specific prescription benefit information upon request, including eligibility, cost-sharing details, and utilization management requirements, effective January 1, 2025.

• Mandates real-time responses to information requests through APIs meeting ANSI-accredited standards, with information current no later than one business day after any changes.

• Prohibits pharmacy benefit managers and health benefit plan issuers from denying or delaying responses to block information release, restricting provider communication with enrollees, or penalizing providers for disclosing information or prescribing lower-cost or clinically appropriate alternative drugs.

• Applies requirements to health benefit plans issued, amended, or renewed on or after January 1, 2025, but excludes Medicaid, CHIP, TRICARE, and workers' compensation insurance.

• Amends the State Employees Group Insurance Act, School Code, Health Maintenance Organization Act, Limited Health Service Organization Act, and Voluntary Health Services Plans Act to require compliance with the new prescription drug information requirements.