Creates the Health Care Availability and Access Board Act. Establishes the Health Care Availability and Access Board to protect State residents, State and local governments, commercial health plans, health care providers, pharmacies licensed in the State, and other stakeholders within the health care system from the high costs of prescription drug products. Contains provisions concerning Board membership and terms; staff for the Board; Board meetings; circumstances under which Board members must recuse themselves; and other matters. Provides that the Board shall perform the following actions in open session: (i) deliberations on whether to subject a prescription drug product to a cost review; and (ii) any vote on whether to impose an upper payment limit on purchases, payments, and payor reimbursements of prescription drug products in the State. Permits the Board to adopt rules to implement the Act and to enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Board. Creates the Health Care Availability and Access Stakeholder Council to provide stakeholder input to assist the Board in making decisions as required by the Act. Contains provisions concerning Council membership, member terms, and other matters. Provides that the Board shall adopt the federal Medicare Maximum Fair Price as the upper payment limit for a prescription drug product intended for use by individuals in the State. Prohibits the Board from creating an upper payment limit that is different from the Medicare Maximum Fair Price for the prescription drug product that has a Medicare Maximum Fair Price. Requires the Board to implement an upper payment limit that is the same as the Medicare Maximum Fair Price no sooner than the Medicare implementation date. Provides that Medicare Part C and D plans are not required to reimburse at the upper payment limit. Provides that the Attorney General may enforce the Act and may pursue any available remedy under State law when enforcing the Act. Effective 180 days after becoming law.
House Floor Amendment No. 4: Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Makes changes to defined terms. Replaces references to the Health Care Availability and Access Board, the Health Care Availability and Access Stakeholder Council, and the Health Care Availability and Access Board Fund to the Prescription Drug Affordability Board, the Prescription Drug Affordability Stakeholder Council, and the Prescription Drug Affordability Board Fund. Requires Prescription Drug Affordability Board membership to also include individuals with expertise in the practice of pharmacy. Includes reimbursements from health benefit plans in provisions concerning upper payment limits for payor reimbursements. Requires the Board to maintain financial records and accounts in accordance with generally accepted governmental accounting principles. Provides that the Board shall be deemed a public body for purposes of the Freedom of Information Act and the Open Meetings Act; all records of the Board, including meeting minutes, cost review records, and correspondence, shall be public records subject to disclosure in accordance with the Freedom of Information Act, except as otherwise provided by law; and meetings of the Board shall be open to the public in accordance with the Open Meetings Act. Requires the Board to establish an operational plan for distribution and access to a drug with an upper payment limit before the Board reviews specific drugs for affordability and establishes any upper payment limits. Provides that the Board shall prioritize establishing and implementing upper payment limits for the 10 prescription drug products with a Medicare Maximum Fair Price that went into effect in 2026 before proceeding with upper payment limits on other prescription drug products with a Medicare Maximum Fair Price or affordability reviews for any other prescription drug products. Adds more items to the list of information that may be included to conduct an affordability review. Provides that the Board may suspend an upper payment limit if it determines that there is a shortage of the drug in the State unless the Board determines that the shortage was caused by a manufacturer or its agent. Changes expertise requirements for membership of the Prescription Drug Affordability Stakeholder Council. Establishes specified exemptions for the Department of Healthcare and Family Services and other State departments in provisions concerning protections and other Board considerations. Provides that any upper payment limit established by the Board shall not apply to prescription drug products purchased by the Department of Healthcare and Family Services for the medical assistance program under Article V of the Illinois Public Aid Code or to a health care plan serving Medicaid populations that provides, arranges for, pays for, or reimburses the cost of any health care service for persons who are enrolled under the medical assistance program under Article V of the Illinois Public Aid Code unless, after consultation with and approval of the Director of Healthcare and Family Services, it is determined that the upper payment limit would reduce costs to the State. Provides that, if a prescription drug product subject to an upper payment limit established under the Act is intended to be made available for purchase by pharmacies, distributors, or wholesalers licensed in the State, it shall be available at a price that does not exceed the upper payment limit (rather than a wholesaler or distributor shall make any prescription drug product that is subject to an upper payment limit established under the Act available for purchase by pharmacies licensed in this State at a price that does not exceed the established upper payment limit), and, if a wholesaler or distributor acquires a prescription drug product subject to an upper payment limit at a price that exceeds the upper payment limit, the wholesaler or distributor is entitled to a chargeback or rebate equal to the difference between the price and the upper payment limit from the entity that sold the product to the wholesaler or distributor. Changes the required reporting date for the Board concerning the operation of the generic drug market in the United States to June 1, 2027 (rather than June 1, 2025). Requires the Board to notify the General Assembly if 5 years have passed without any litigation hindering Board operations. Provides that the Act is repealed 5 years after the effective date of the Act. Makes other changes. Effective 180 days after becoming law.

Statutes affected:
Introduced: 30 ILCS 105/5
Engrossed: 30 ILCS 105/5