Bill
HB 3705
Requires state employee and school health plans to provide extensive mandated drug benefits and tightens PBM rules to boost affordability and oversight.
Status: House Committee Amendment No. 1 filed 3/17/2025; Re‑referred to Rules Committee. (Original bill filed 2/18/2025; chief sponsor changed to Rep. Natalie A. Manley.)
Summary
- House Amendment 001 replaces the original bill text and retitles the measure as the "Prescription Drug Affordability Act."
- The amendment primarily amends the State Employees Group Insurance Act of 1971, the School Code, and multiple sections of the Illinois Insurance Code (including substantial changes to provisions governing pharmacy benefit managers (PBMs), referenced as Sections 513b1 and 513b3 and adding 513b1.1).
- The amendment also contains a minor, technical change to the Network Adequacy and Transparency Act (fixing a duplicated word in the short title).
Main purpose and intent
- To strengthen and clarify mandated drug and health‑benefit coverage requirements for State employee and school‑related health plans.
- To expand regulation and oversight of PBMs (definitions, scope, and contractual requirements), and to protect certain programs and entities involved in drug dispensing (e.g., 340B entities and pharmacies).
- To assign enforcement responsibilities among State agencies and to condition certain rulemaking authority on compliance with the Illinois Administrative Procedure Act and Joint Committee on Administrative Rules procedures.
Key provisions and changes
- Coverage mandates:
- Amends Section 6.11 of the State Employees Group Insurance Act to require that the State employee benefits program provide coverage required by a long list of specified sections of the Illinois Insurance Code (many enumerated 356-series and 370-series sections). The program must also comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, 370c.1 and Article XXXIIB.
- Amends Section 10‑22.3f of the School Code to require school‑provided insurance policies to include similar mandated benefits (same list of Insurance Code sections) and compliance with designated Insurance Code sections.
- Enforcement:
- The Department of Insurance is charged with enforcing specified subsections (notably Sections 370c and 370c.1 and Article XXXIIB); other requirements under the amended State Employees Group Insurance Act are to be enforced by the Department of Central Management Services (CMS).
- PBM regulation (amendments to Section 513b1 and related sections):
- Adds or revises statutory definitions used in PBM and contracting provisions, including: 340B drug discount program, 340B entity, 340B pharmacy, affiliate, biological product, brand‑name drug, generic drug, covered individual, critical access pharmacy, drugs (per Pharmacy Practice Act), complex or chronic medical condition, and health benefit plan.
- Explicitly states that “health benefit plan” includes self‑funded employer welfare arrangements (text truncated in available file but indicates broader inclusion of self‑funded plans).
- The amendment text references protections and rules related to 340B entities and pharmacies and appears to expand transparency/contracting requirements for PBMs (full operative language in these sections is partially truncated in the published amendment).
- Rulemaking limitation:
- Any rulemaking authority to implement prior public acts (e.g., Public Act 95‑1045) is conditioned upon adoption strictly in accordance with the Illinois Administrative Procedure Act and JCAR procedures; improperly adopted rules are declared unauthorized.
Who would be affected
- State employees covered by the State Employees Group Insurance Program and employees covered under school district insurance policies.
- Private and public health insurers and administrators offering plans in Illinois, including self‑funded employer plans.
- Pharmacy benefit managers (PBMs) — increased statutory definitions and regulatory attention.
- 340B entities and 340B pharmacies, critical access pharmacies, and other pharmacies dispensing drugs to covered individuals.
- State agencies responsible for enforcement (Department of Insurance and Department of Central Management Services).
- Covered individuals/beneficiaries who may see changes in covered benefits, provider access, or drug dispensing practices.
Procedural/timeline notes
- Original bill (introduced by Rep. Robyn Gabel) filed 2/18/2025. Chief sponsorship changed to Rep. Natalie A. Manley.
- House Amendment 001 filed 3/17/2025; amendment then routed through committees and re‑referred to Rules Committee (various entries 3/17–3/26/2025).
- Read first time in the House 3/26/2025 and referred to the Public Health Committee earlier in March.
- Current status: the bill as amended remains under committee referral for further consideration; full, finalized statutory language for some insurance/PBM provisions was truncated in the posted amendment and may be supplemented in the bill file for committee review.
Potential impact and considerations
- Intended to increase mandated coverage consistency across state and school plans and enhance oversight of PBMs, which could affect prescription access, plan costs, and administrative requirements for insurers and PBMs.
- The inclusion of self‑funded plans and protections for 340B entities could alter contracting, reimbursement, and pharmacy network practices.
- Exact fiscal impact (on the state, school districts, insurers, or beneficiaries) is not specified in the amendment text provided and would depend on final language and implementing rules.
Note
- The amendment text provided is partially truncated in the legislative file (particularly within the Insurance Code PBM section). The summary reflects the explicit language available; committee reports or a complete engrossed bill text will provide the final operative provisions.
Compiled from official sources — confirm details with the bill’s official record.
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