HB 5514

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Chief Procurement Officer for General Services, in consultation with the Department of Healthcare and Family Services, to conduct and complete, no later than one year after the effective date of the amendatory Act, any procurement necessary to select a third-party administrator to serve as the single State pharmacy benefit manager for the medical assistance program and to be used by all Medicaid managed care organizations under contract with the Department. Provides that, beginning on January 1, 2028, the selected pharmacy benefit manager shall be responsible for managing and processing all pharmacy claims under the medical assistance program, including pharmacy claims from contracted Medicaid managed care organizations. Provides that the Department is responsible for enforcing the pharmacy benefit manager contract after the procurement process. Sets forth certain activities the Director of Healthcare and Family Services must do as part of the procurement process, including: (i) establishing eligibility criteria an entity must meet in order to become the State pharmacy benefit manager; and (ii) developing a master contract that incorporates all pharmacy benefit manager contract requirements under the Illinois Insurance Code, with some exceptions. Requires a prospective State pharmacy benefit manager to disclose certain information during the procurement process, including, but not limited to: (i) any conflicts of interest; (ii) any common ownership, board membership, or other control the pharmacy benefit manager has over a Medicaid managed care organization or other specified entities; and (iii) any financial terms and arrangements between the pharmacy benefit manager and a prescription drug manufacturer or labeler. Effective immediately.