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HB 3794

Relating to municipal solid waste; and prescribing an effective date.

2025 Regular Session Introduced by Tom Andersen and 10 co-sponsors

HB 3794 requires rebates to reduce point-of-sale prices by at least 80% for patient cost-sharing, while keeping rebate amounts confidential and expanding biosimilar substitution.

Chapter 579, (2025 Laws): Effective date September 26, 2025.
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Bill Summary · HB 3794

HB 3794 — Summary (Chapter 579, 2025 Laws)

Status: Enacted — Governor signed July 24, 2025. Effective date: September 26, 2025.
Primary sponsor: Rep. Ryan Spain. Companion: SB 1859.

Purpose / Intent

HB 3794 reforms how prescription-drug rebates are treated for patient cost-sharing at retail point-of-sale and makes related changes to disclosure rules and pharmacist substitution authority for biological products. The bill is intended to reduce out‑of‑pocket spending by ensuring a large share of manufacturer rebates are reflected in the price used to calculate a covered individual’s copayment or coinsurance, while also restricting public disclosure of rebate details.

Key provisions

  • Rebates applied to patient cost-sharing (Insurance/PBM rule)

    • Amends the Pharmacy Benefit Manager provisions of the Illinois Insurance Code (215 ILCS 5/513b1).
    • Requires a covered individual’s defined cost sharing for each prescription drug to be calculated at the point of sale using a price reduced by an amount equal to at least 80% of all rebates "received, or to be received" in connection with dispensing or administering that prescription drug.
    • Applies to insurer health plans operating in Illinois (includes plans using PBMs/agents).

  • Confidentiality of rebate information / FOIA change

    • Prohibits a health insurer or its agents from publishing or otherwise revealing the actual amount of rebates the insurer receives on a product or therapeutic class, on a manufacturer-specific or pharmacy-specific basis.
    • Declares such rebate information confidential and not subject to public disclosure.
    • Amends the Freedom of Information Act (5 ILCS 140/7.5) to add a conforming statutory exemption for that confidential rebate information.

  • Pharmacist substitution of biologics (Pharmacy Practice Act)

    • Amends the Pharmacy Practice Act (225 ILCS 85/19.5) to allow a pharmacist to substitute a biological product (not limited to only FDA-designated "interchangeable" products) if the product considered for substitution is either the reference product or an FDA‑approved biosimilar of the prescribed biological product, subject to other statutory requirements and notification rules. (This relaxes the prior requirement that substitution be limited to FDA‑designated interchangeable biologics.)

  • Definitions and conforming changes

    • The bill includes definitions for terms used in these provisions and makes conforming edits across affected statutes.

Who is affected

  • Covered individuals / patients — likely lower copayments or coinsurance at point of sale to the extent rebates are captured and passed through.
  • Health insurers, pharmacy benefit managers (PBMs), and plan sponsors — must implement accounting and pricing changes to reflect rebate pass-through and maintain confidentiality rules.
  • Pharmacies and pharmacists — new substitution rules for biologic products could increase substitution options (subject to notification/other legal limits).
  • Drug manufacturers — rebates remain contractual but 80% must be used to reduce point-of-sale pricing for patients.
  • Public records requesters — rebate amounts will be excluded from FOIA disclosure.

Potential impacts and considerations

  • Patient cost-sharing may decrease at pharmacy counter for many drugs, depending on rebate flows and contract structures.
  • Insurers/PBMs will need operational changes to calculate and apply the 80% rebate reduction at point of sale and to maintain rebate confidentiality.
  • The confidentiality exemption reduces public transparency about the actual dollar amounts of rebates by manufacturer or pharmacy, which could limit external oversight or analysis of net drug prices.
  • Allowing substitution of FDA‑approved biosimilars (not only FDA‑designated interchangeable biologics) may increase biosimilar use and competition subject to pharmacy practice rules and patient/physician notification requirements.

Statutory citations

  • FOIA: 5 ILCS 140/7.5 (amended)
  • Illinois Insurance Code / PBM provisions: 215 ILCS 5/513b1 (amended)
  • Pharmacy Practice Act: 225 ILCS 85/19.5 (amended)

Effective date: September 26, 2025.

Compiled from official sources — confirm details with the bill’s official record.

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