New Illinois Law Promotes PBM Transparency

JB Pritzker

The fight against pharmacy benefit managers (PBMs) has gained more ground this month as Illinois Governor JB Pritzker signed HB 3631 into law. The legislation, led by Democratic Representatives Hoan Huynh and Mike Simmons prohibits PBMs from retaliating against pharmacists who disclose information through the course of government proceedings, if that pharmacist had “reasonable cause” to believe that the information is evidence of a violation of a state or federal law, rule, or regulation.1

Pritzker signed the bill on August 4, 2023.

Pharmacists who speak out against PBMs have experienced retaliatory measures, including an “exponential increase in audits, refusal to access future contracts, and removal from preferred provider networks,” according to a National Community Pharmacists Association (NCPA) press release.1

NCPA and the Illinois Pharmacists Association have applauded the bill. “PBMs…have been weaponizing contracting and auditing tactics to essentially force pharmacists into silence,” said Garth Reynolds, RPh, Illinois Pharmacists Association executive director, in a press release.1 “With HB 3631, we can more freely share with government representatives how PBM policies harm pharmacy practice and our patients.”

Joel Kurzman, director of state government affairs at the NCPA, also praised the legislation. “For a marketplace to be free and healthy, there must be competition and transparency,” he said. “PBM-insurers are fighting against both, even as policymakers at all levels of government look to crack down on business practices that stifle patient choice and disadvantage independent pharmacies.”1

“This legislation is a great step forward in Illinois,” he continued. “Further PBM reforms and aggressive enforcement of policies like this one will be crucial if patients and taxpayers are to see the difference.”

Pritzker has previously enacted legislation aimed at managing PBMs. In 2019, he signed HB 465, which created Illinois’ first comprehensive regulatory framework for PBMs. Per the legislation, insurers are now required to apply third-party payments, discounts, vouchers, and copay cards to a deductible, copay, or out-of-pocket maximum associated with health insurance; prevent gag clauses limiting pharmacists from advising patients about available lower-cost alternatives or cash pay options; and provide greater transparency around the pricing and reimbursement models used by PBMs by requiring state agencies to approve contracts impacting Medicaid.2

References

IPhA, NCPA cheer Illinois law reigning in PBM retaliation. News release. National Community Pharmacists Association. August 11, 2023. Accessed August 12, 2023. https://ncpa.org/newsroom/news-releases/2023/08/11/ipha-ncpa-cheer-illinois-law-reining-pbm-retaliation

Illinois governor signs sweeping PBM legislation. News release. National Community Pharmacists Association. August 26, 2019. Accessed August 12, 2023. https://ncpa.org/newsroom/qam/2019/08/27/illinois-governor-signs-sweeping-pbm-legislation

The story originally appeared on Drug Topics.