(320 ILCS 55/25)
Sec. 25. Program administration.
(a) The Department is authorized under this Act to be the program administrator. If the Department is not the program administrator, 90 days after the effective date of this Act, the Department must issue a request for proposals for bidders interested in administering the program. Bidders must compete on the basis of the following minimum criteria:
(1) The Director shall solicit and accept proposals
from entities to provide for administration of a program or programs in accordance with rules adopted under Section 45. Proposals must be submitted not later than a date established by the Director. The Director shall accept only those proposals that specify the following:
(A) The amount of the discount based on the AWP
of the covered medications.
(B) Administrative fees changed by the entity.
(C) Annual membership fees to the cardholders.
(D) The estimated number and geographic
distribution of participating pharmacies in the administrator's pharmacy network.
(E) The plan for pharmacy compensation.
(F) The method used for determining the
prescription drugs to be covered by the program, and the criteria and process for establishing a preferred drug list, if applicable.
(G) How the entity proposes to improve medication
management for cardholders, including any program of disease management.
(H) How cardholders will be informed of the
discounted price negotiated by the entity.
(I) How the entity will handle complaints about
the program's operation.
(J) The entity's previous experience in managing
(K) Any additional information requested by the
(2) The Director shall contract with one or more
entities to administer a program or programs on the basis of the proposals submitted, but may require an administrator to modify its conduct of a program in accordance with rules adopted under Section 45.
The Director shall adopt rules specifying the period for which a contract will be in effect and may terminate a contract if an administrator fails to conduct a program in accordance with its proposal or with any modifications required by rule. When a contract period ends or a contract is terminated, the Director shall enter into a new contract in the manner specified in this Section for an original contract. Prior to making a new contract, the Director may modify the rules for administration of the program or programs.
(b) As used in this Section, "administrator" includes the administrator's parent company and any subsidiary of the parent company.
(1) No administrator shall sell any information
concerning a person who holds a prescription drug discount card, other than aggregate information that does not identify the cardholder or the physician prescribing the medication, without the cardholder's written consent.
(2) Unless an administrator has the cardholder's
written consent, no administrator shall use any personally identifiable information that it obtains concerning a cardholder through the program to promote or sell a program or product offered by the administrator that is not related to the administration of the program. This subsection (b) does not prohibit an administrator from contacting cardholders concerning participation in or administration of the program, including, but not limited to, mailing a list of pharmacies participating in the program's network or participating in disease management programs.
(4) The administrator shall not use any funds
generated from rebates, discounts, administrative fees, or other fees to promote its mail order pharmacy operation or the mail order pharmacy operation of an affiliate.
(d) The contract between the Department and a pharmacy benefits manager must, at a minimum, meet the criteria of subsection (a). The contract must also require notification by the pharmacy benefits manager of any proposed or ongoing activity that involves, directly or indirectly, any conflict of interest on the part of the pharmacy benefits manager. The Department shall ensure that the pharmacy benefits manager complies with the contract and shall adopt all procedures necessary to enforce the contract.
(f) The Department or program administrator shall reimburse pharmacies at negotiated rates based on market conditions.
(Source: P.A. 93-18, eff. 7-1-03; 94-86, eff. 1-1-06.)
Last modified: February 18, 2015