The legislation, House Bill 465, passed unanimously in the
But the bill, if signed into law by Gov.
"This won't solve the whole reimbursement issue," Reynolds said. "It is the first of many steps so that the abuses slow down or stop."
Independent pharmacies, especially those in central and southern
The increased financial pressure has contributed to several downstate pharmacies shutting their doors, Reynolds said.
HB 465 would require PBMs -- which work for companies carrying out the state's Medicaid managed-care program and also for private insurance companies -- to disclose their pricing systems and other data to the
The data could lead to future restrictions on PBMs and would create an "enforceable appeals process" that pharmacies could use if they believe they are being wronged by PBMs, Reynolds said.
The bill also would do away with "gag clauses" in PBM contracts that prevent pharmacists from informing patients about lower-cost alternatives, even if paying the full cash price for a drug may be cheaper than paying a co-payment.
A group representing PBMs, the
PBMs are hired by managed-care organizations, or MCOs, to process payments to pharmacies. PBMs contend that they use their purchasing power to save money for the state and private insurance companies that use them as a middleman.
Independent pharmacies contend that PBMs may be padding their own profit margins by unfairly reducing rates paid to pharmacies and failing to pass on the savings to the state and other insurers that employ PBMs.
Reynolds said pharmacies also have seen their per-prescription "dispensing fee" from Medicaid -- designed to cover professional services -- drop from
Illinois MCOs -- such as BlueCross and
About 30 percent of the total revenue for Dyer's pharmacies comes from Medicaid, and she said the 2018 reboot of the state's Medicaid managed-care program, known as HealthChoice Illinois, reduced her stores' Medicaid reimbursements by 15 percent to 20 percent.
Dyer said HB 465 is "not an immediate help, but it's laying some good groundwork. It also puts in place some restrictions and guidelines on pricing."
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