Illinois2026Active
HB0004
Medicaid Pharmacy Services and Access Study
Last scannedAug 24, 2026, 10:00 AM
In one sentence
This law requires a study on pharmacy access for Medicaid patients in impacted areas and mandates that eligible local pharmacies serve residents living in their zip code, even if the pharmacy does not have a contract with the patient's insurance plan.
What it does
- Requires the Department of Healthcare and Family Services to conduct a study on managed care pharmacy access standards.
- Directs the study to review current standards with a focus on disproportionately impacted areas.
- Requires the Department to seek input from consumers who use pharmacy services.
- Mandates that eligible retail pharmacies serve Medicaid recipients living in the same zip code, regardless of whether they have a contract with the recipient's insurance plan.
- Excludes pharmacies under investigation or sanctioned for fraud, waste, or abuse from this service requirement.
- Requires managed care organizations to pay these pharmacies their standard contractual rate for services provided under this rule.
- Orders the Department to report its study findings to the Governor and General Assembly by January 1, 2026.
- Requires the Department to publish the final report on its website.
Who it affects
- The Illinois Department of Healthcare and Family Services
- Retail pharmacies enrolled in the medical assistance program that are not under fraud investigation or sanction
- Medicaid recipients living near participating pharmacies
- Managed care organizations providing insurance for Medicaid patients
Limits and unknowns
- The law does not specify the exact methods pharmacies must use to handle patients outside their insurance network.
- The final report on access standards is due by January 1, 2026, so current data gaps remain until then.
Plain language
Terms to know
- Medical Assistance Program
- The official name used in the bill for the state's Medicaid program.
- Managed Care Organization
- An insurance company that manages healthcare services for recipients enrolled with them.
- Disproportionately Impacted Areas
- Regions or communities identified in the study as facing greater challenges accessing pharmacy services.
Official record
Sources
Official summary
MEDICAID-PHARMACY SERVICES