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Tuesday, July 5, 2022

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Working to Rein in Prescription Drug Costs, Gov. Pritzker Signs Legislation Creating Comprehensive Regulatory Framework for PBMs

Working to rein in the rising costs of prescription drugs in Illinois, Governor JB Pritzker signed legislation that creates the state’s first comprehensive regulatory framework for pharmacy benefit managers, or PBMs, which negotiate drug prices and benefits on behalf of insurance plans.
 
“Lowering health care costs for Illinois families is one of my top priorities as governor, and I’m proud this legislation will regulate pharmacy benefit managers to put patients first,” said Governor JB Pritzker. “With this new law on the books, we’re increasing access to life-saving prescription drugs and taking steps to reduce out-of-pocket costs so every Illinoisan can live a healthy life.”
 
Falling under the Illinois Department of Insurance, the new PBM regulations take several steps to increase access to health care and protect patients:

• Requires insurers to apply third-party payments, discounts, vouchers and co-pay cards to a deductible, the co-pay or out-of-pocket maximum associated with health insurance
• Prevents gag clauses which limit pharmacists from advising patients when lower-cost alternatives may be available or when paying cash is cheaper than using insurance
• Protects consumers entering the emergency room from being denied coverage, even if their ailment turns out to be a non-emergency
• Provides more transparency in the pricing and reimbursement models PBM utilize by requiring HFS to approval contracts that impact Medicaid

“This is the first time we have been able to pass a law regulating PBMs in Illinois,” said House Majority Leader Greg Harris (D-Chicago). “We need strict regulation to bring drug prices down and make prescriptions more affordable. Also, I’m very glad that this new law specifically prohibits several anti-consumer and anti-competitive practices that have driven drug prices up.”

House Bill 465 takes effect on January 1, 2020.
 
Drug prices continue to skyrocket, forcing patients to pay more for life-saving medications. According to a recent Kaiser Family Foundation survey, nearly one out of every three patients are skipping their recommended prescription drugs due to the cost.

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