IL|The Illinois Department of Insurance Bulletin 2026-07 clarifies that, as of January 1, 2026, all “f‑dash” subsections (f‑5 through f‑25) of Section 513b1 of the Illinois Insurance Code added by the Prescription Drug and Affordability Act apply fully to PBMs and Medicaid managed care entities, with no Medicaid exemption for these provisions. These requirements include bans on spread pricing and steering, full pass‑through of manufacturer remuneration, protections against inappropriate specialty drug designation to limit pharmacy access, and annual audit and reporting obligations around rebates and fees, all of which expressly encompass Medicaid managed care plans and their PBM arrangements. The Department emphasizes that the only Medicaid‑related carve‑out in Section 513b1 is contained in subsection (f) for certain 340B contract terms, and that this exemption does not extend to subsections (f‑5) through (f‑25), which have been in force for Medicaid managed care since they took effect on January 1, 2026.
- PBMs and their affiliates must comply with subsections (f‑5) through (f‑25) for Medicaid managed care plans, while Medicaid managed care entities (as “insurers”) must directly comply at least with subsections (f‑10), (f‑20), and (f‑25).
- Key substantive requirements include: no spread pricing (f‑5), no steering of covered individuals by PBMs or insurers (f‑10), 100% pass‑through of manufacturer payments plus reporting duties (f‑15), restrictions on using “specialty drug” designations to limit network access (f‑20), and mandatory annual rebate/fee audits with DOI access to records (f‑25).