ILLINOIS SUMMARY OF EXISTING LAW

Requires PBMs to update MAC pricing every 7 days; provide appeals process including 14 days for pharmacy to file appeal and PBM must responding in 14 days; if appeal denied PBM must provide basis for denial; if appeal sustained PBM must adjust price for all similarly situated pharmacies.

Link to Existing Law: 215 ILCS 5/513b1

Given the appeal can only be made to the PBM, there is opportunity to advocate for a stronger regulatory scheme and oversight of PBM. The law could also be strengthened by requiring PBMs to identify the specific source of where a lesser cost product could be obtained.