Gov. JB Pritzker signed two bills Tuesday to rein in “predatory practices” by pharmacy benefit managers (PBMs) and expand consumer protections for health insurance.  

House Bill 1697, titled the Prescription Drug Affordability Act, adds some regulations for PBMs, who assist in negotiations between pharmacies, drug manufacturers and insurance companies. 

Discussions of federal regulation of the industry have stalled. Pritzker announced his intention to pursue state regulations during his budget address in February.  

“For too long, our healthcare 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 the bill signing Tuesday. “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.” 

The measure bans spread pricing, where PBMs charge Medicaid more for the drug than it costs and receive part of the extra money. It also requires them to give 100 percent of the rebate they receive from drug manufacturers to the health insurance sponsor, employer or covered individual. It also requires them to disclose how much they received in rebates to the state.  

The measure prohibits PBMs from “steering” an individual to one of their affiliated pharmacies and, finally, it creates a $15 enrollment fee for PBMs in the state. That money will fund grants for community pharmacies that serve low-income, rural and underserved communities.    

David Bagot, owner of Petersburg Pharmacy and president of the Illinois Pharmacists Association, said while this bill will provide needed relief for many community pharmacies across the state, there is still more work that needs to be done to ensure these pharmacies remain open.  

“Too many communities, especially in rural and urban, underserved areas remain at risk of losing the very pharmacies they rely on,” he said. “This is why the pharmacy investment components of the Prescription Drug Affordability Act are so important.”   

The measure passed with bipartisan support in the House and Senate. Sen. Dale Fowler (R-Harrisburg) said the measure received bipartisan support because of the support provided to community pharmacies.  

“They aren't just a business,” Fowler said. “They are a lifeline. They know their patients by name. They check in on their elders. They deliver medications when no one else will. They've been in the forefront for all of this fight, from the very beginning, not just for their own survival, but for every independent, family-owned pharmacy in the state of Illinois.”  

Pritzker also signed House bill 3019, which builds upon health insurance reforms signed into law in 2024.  

Read more: Pritzker signs health insurance overhaul hoping to improve coverage for consumers  

The 2024 initiative banned prior authorizations for mental health emergencies. HB 3019 expands that to also include outpatient mental health services and partial hospitalization mental health services.  

The measure also requires health insurance companies to cover travel expenses for some instances where there is not a local treatment option. It also prohibits insurance companies from using health insurance premiums for certain administrative costs, such as executive bonuses or broker fees.   

Pritzker said the legislation will ensure people in need of mental health services can get treated without the stress of first getting prior authorization.  

“I have a friend… whose daughter attempted to commit suicide, and he was in the ambulance on the way to the hospital when he realized, in order to check into the hospital, he needed to get prior authorization,” Pritzker said. “He was on the phone with the insurance company at midnight, while his daughter is laying on a gurney in the ambulance, and they're denying him.”  

Both measures go into effect Jan. 1, 2026. 

Pritzker says state can’t cover Medicaid cuts under federal bill  

After the U.S. Senate narrowly approved a budget reconciliation bill Tuesday that includes cuts to Medicaid, Pritzker said more than 500,000 Illinoisans could lose coverage.  

According to projections from the Senate Democrat’s Joint Economic Committee, the measure would cause 535,849 in Illinois to lose coverage. If an amendment to end the Medicaid expansion is added, more than 1.1 million would lose coverage.  

“It’s going to be very hard to recover,” Pritzker said. “The state of Illinois can't cover the cost. No state in the country can cover the cost of reinstating that health insurance that is today paid for mostly by the federal government.”  

Pritzker said he wouldn’t be surprised if hospitals in Central and Southern Illinois closed because of the bill, which still needs to be voted on by the U.S. House of Representatives.