Pritzker signs health care legislation
[July 02, 2025]
By Peter Hancock
Gov. JB Pritzker signed a pair of health care-related bills Tuesday that
he said would put more controls on the pricing of pharmaceutical drugs
sold through insurance plans while expanding insurance coverage for
certain kinds of hospital costs.
“For too long our health care system has been infected by profit-seeking
middlemen and predatory actors looking to make an extra dime at the
expense of Illinois patients,” Pritzker said at a bill signing ceremony
in Peoria. “Seniors have been forced to pay through the nose for
life-saving medications. Families have had to delay or decline medically
necessary treatments because they can’t afford it anymore. And family
businesses like independent pharmacies have had to shut their doors.”
House Bill 1697, known as the Prescription Drug Affordability Act, will
impose new restrictions on practices of pharmacy benefit managers, or
PBMs, a powerful but little-understood segment of the pharmaceutical
industry.
PBMs are companies that act as a kind of middleman between health
insurance plans and pharmaceutical companies by negotiating drug prices
and designing drug formularies that are intended to steer patients
toward lower-cost medications.
But they have come under intense criticism in recent years for steering
patients toward their own affiliated retail chain pharmacies, often to
the detriment of smaller independent pharmacies, and for operating
pricing systems that are designed to maximize profits for the PBMs
rather than producing savings for patients.
Under the legislation, PBMs will be prohibited from steering consumers
toward large pharmacies in which they have a financial interest. They
will also be prohibited from engaging in “spread pricing” – the practice
of charging health plans a higher price for a drug than the PBM pays a
pharmacy for dispensing the drug.
The bill also establishes a grant program that will distribute $25
million a year in financial support for independent pharmacies, funded
through a tax levied on PBMs operating in Illinois.
David Bagot, an independent pharmacist from Petersburg who is also
president of the Illinois Pharmacists Association, called the bill
“landmark legislation” that he predicted would be studied and replicated
in other states.
“This bill represents the most comprehensive reform of pharmacy benefit
managers we have seen in Illinois,” he said. “For far too long, these
companies have used our nation’s drug supply chain to benefit
shareholders and executives while driving up costs for people who rely
on medications and driving pharmacies out of business.”
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Gov. JB Pritzker signs two bills related to health care costs at a
hospital in Peoria, including a bill that puts more controls on
pharmacy benefit managers. (Capitol News Illinois photo by Andrew
Campbell)
But the Pharmaceutical Care Management Association, the lobbying
organization that represents PBMs, called the bill “misguided
legislation” and predicted it would have little or no impact on the
prices consumers pay for medications.
“Unfortunately, the legislation does nothing to address the fact that
Big Pharma sets the price of the prescription drugs – and the price is
the problem when it comes to some Illinoisans facing difficulty
affording their prescription drugs,” the group said in a statement.
“Lawmakers have passed 20 bills regulating and restricting PBMs since
2016, none of which have led to lower drug prices.”
Insurance coverage expansion
Pritzker also signed House Bill 3019, known as the Healthcare Protection
Expansion Act.
Among other things, it prohibits state-regulated health plans from
requiring prior authorization for outpatient mental health services.
Last year, lawmakers imposed a similar prohibition for inpatient and
emergency mental health services.
It also requires insurance plans to cover a patient’s travel-related
expenses whenever they have to travel long distances to receive
in-network care, a problem often faced by patients who live in rural
areas of the state.
“Building on protections that make mental health care accessible for all
Illinois residents, this law gives people more opportunities and
flexibility to receive necessary services,” state Sen. Laura Fine,
D-Glenview, a lead sponsor of the bill, said in a statement.
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