Gov. Pritzker Signs Healthcare Bills Lowering Prescription Drugs Costs and Expanding Healthcare Access ​

PEORIA — Today, Governor JB Pritzker joined Attorney General Kwame Raoul, healthcare advocates, independent pharmacists, and legislators to sign into law the Prescription Drug Affordability Act (HB 1697) and the Healthcare Protection Expansion Act (HB 3019), which will lower prescription drug costs and expand healthcare access, respectively. These reforms deliver on Gov. Pritzker’s healthcare initiatives outlined earlier this year and build on his commitment to improving affordability and access in Illinois’ healthcare system.

“For too long, our healthcare system has been infected by profit-seeking middlemen and predatory actors looking to make an extra dime at the expense of Illinois patients,” said Governor JB Pritzker. “Affordability is our watchword in Illinois, and the bills I signed today are another step toward quality and affordable healthcare for all by lowering costs for families and providing transformational relief to those who need it most.”

"The relentless rise of prescription drug prices has cost hard working families too much for too long - not just dollars, but health, comfort, and for some, precious time with loved ones, said Lt. Governor Juliana Stratton. Pharmacy benefit managers have put independent pharmacies out of business in underserved areas, like many rural communities in Illinois, and forced people to pay absurd amounts for critical medication. Their unchecked greed ends today; Governor Pritzker and I will never stop working to make health care more affordable for every Illinoisan."

“Pharmacy benefit managers were intended to reduce out-of-pocket costs for patients, not to drive up their own profits at the expense of patients. Unfortunately, PBMs have been largely unregulated for decades, and the Prescription Drug Affordability Act is an important new tool to support our efforts to hold them accountable for abusive practices,” said Illinois Attorney General Kwame Raoul. “My office has worked diligently to recover more than $100 million from the nation’s largest PBMs for their deceptive practices and opportunistic control of the pharmaceutical market. I am proud to join Gov. Pritzker as he signs this law to help reform the industry. I will continue to work with the governor and other state attorneys general to hold ensure patients are protected from deceitful PBM practices in Illinois and across the country.”

A brief overview of each bill can be found below, followed by more detailed descriptions:

Prescription Drug Affordability Act:

HB 1697 – Prescription Drug Affordability Act
​Sponsored by Sen. David Koehler and Rep. Natalie Manley, HB 1697 tackles predatory practices used by pharmacy benefit managers to inflate their revenue and drive health care costs up. ​ HB 1697 bans spread pricing and steering by PBMs to pharmacies they own or control and limits the misclassification of commonly used medications as "specialty drugs.” It also requires that the contract between a PBM and a health insurer include a provision requiring an annual compliance audit of the PBM. PBMs that are found non-compliant with these provisions will now have to pay $10,000 per day per offense, rather than $1,000 per day per offense. The bill streamlines the Critical Access Pharmacy program administered by the Department of Healthcare and Family Services (HFS), providing assistance to pharmacies in rural and underserved communities. The bill also establishes a new a $25 million grant through the Department of Commerce and Economic Opportunity (DCEO) for the creation of the Prescription Drug Affordability Grant program to support independent pharmacists.

Healthcare Protection Expansion Act:

HB 3019 – Healthcare Protection Expansion Act

Sponsored by Sen. Laura Fine and Rep. Lindsey LaPointe ​ HB, 3019 builds on Gov. Pritzker’s Health Care Protection Act passed last year by further strengthening consumer protections in health insurance coverage by increasing transparency in coverage decisions, reducing surprise billing, and expanding access to essential health benefits. It notably expands banning prior authorization for additional mental health services, such as outpatient mental health services and partial hospitalization services, removing insurance barriers that have long delayed or denied care. It also addresses the needs of rural communities by requiring insurers to reimburse patients for reasonable travel-related costs when they must travel beyond network adequacy limits to receive in-network care. The bill also takes the step to explicitly prohibit insurance companies from including items such as executive compensation beyond base salary, surplus profit, or costs associated with lifestyle management apps in their Medical Loss Ratio, clarifying that these items are not “medical care.”

“This is nation-leading legislation that significantly bolsters consumer protections for Illinoisians,” said IDOI Director Ann Gillespie. “The Prescription Drug Affordability Act’s strong transparency requirements will ensure that cost savings go to Illinois health insurance plan sponsors and consumers, not companies. We stand ready to enforce the new laws.”

“When we look at what’s happening in Washington, now more than ever we need to strengthen protections and affordable access to healthcare and prescriptions,” said Leader Jehan Gordon-Booth (D-Peoria). “This measure is a meaningful step forward that will deliver needed transparency, prevent exploitation, and ensure families can access the medication they need.”

“As someone who represents a largely rural district, I understand just how critical our local, independent pharmacies are to the health and well-being of our communities. House Bill 1697 is a major step forward in ensuring patients have access to affordable prescription drugs while protecting the small pharmacies that serve as lifelines in so many areas of Illinois," said Deputy House Republican Leader Norine Hammond (R-Macomb). "I’m proud to support this bipartisan legislation that brings transparency and accountability to pharmacy benefit managers and puts patients and pharmacists first."

"Local pharmacies serve as trusted health care resources, particularly in underserved and rural communities," said State Senator Dave Koehler (D-Peoria). "This law protects consumers and community pharmacies from harmful PBM practices and prevents pharmacy deserts across Illinois."

"Building on protections that make mental health care accessible for all Illinois residents, this law gives people more opportunities and flexibility to receive necessary services,” said State Senator Laura Fine (D-Glenview). “It also ensures that premium dollars are focused on health care, not inflated CEO bonuses.”

“The Prescription Drug Affordability Act prioritizes the health of Illinoisans by curbing the influence of PBMs, who are driving smaller pharmacies out of business and soaking up padded profits,” said State Rep. Natalie Manley (D-Joliet). “By outlawing the deceptive tactics PBMs use to unjustly inflate drug prices, residents and smaller pharmacies can anticipate some relief now that these regulations are codified to counter their market dominance.”

​“Eliminating outpatient prior authorization for both state-based commercial insurance and Medicaid is a huge step forward for mental health prevention and access, allowing for more timely connections to the basic mental health care that so many of us need at different times in our lives,” said State Rep. Lindsey LaPointe (D-Chicago). “Today, more than 90% of Illinois residents are covered by some type of insurance so we must fight to ensure people can seamlessly rely on the insurance they already pay for to access timely mental health care, from regular therapy to in-patient options.”