HEALTH CARE AVAILABILITY

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB0066

Introduced 1/13/2025, by Sen. Robert Peters

SYNOPSIS AS INTRODUCED:

New Act
30 ILCS 105/5.1030 new

Creates the Health Care Availability and Access Board Act.
Establishes the Health Care Availability and Access Board to protect State
residents, State and local governments, commercial health plans, health
care providers, pharmacies licensed in the State, and other stakeholders
within the health care system from the high costs of prescription drug
products. Contains provisions concerning Board membership and terms; staff
for the Board; Board meetings; circumstances under which Board members
must recuse themselves; and other matters. Provides that the Board shall
perform the following actions in open session: (i) deliberations on
whether to subject a prescription drug product to a cost review; and (ii)
any vote on whether to impose an upper payment limit on purchases,
payments, and payor reimbursements of prescription drug products in the
State. Permits the Board to adopt rules to implement the Act and to enter
into a contract with a qualified, independent third party for any service
necessary to carry out the powers and duties of the Board. Creates the
Health Care Availability and Access Stakeholder Council to provide
stakeholder input to assist the Board in making decisions as required by
the Act. Contains provisions concerning Council membership, member terms,
and other matters. Provides that the Board shall adopt the federal
Medicare Maximum Fair Price as the upper payment limit for a prescription
drug product intended for use by individuals in the State. Prohibits the
Board from creating an upper payment limit that is different from the
Medicare Maximum Fair Price for the prescription drug product that has a
Medicare Maximum Fair Price. Requires the Board to implement an upper
payment limit that is the same as the Medicare Maximum Fair Price no sooner
than the Medicare implementation date. Provides that Medicare Part C and D
plans are not required to reimburse at the upper payment limit. Provides
that the Attorney General may enforce the Act and may pursue any available
remedy under State law when enforcing the Act. Effective 180 days after
becoming law.
LRB104 07474 BAB 17516 b

A BILL FOR

SB0066
LRB104 07474 BAB 17516 b
1

AN ACT concerning health.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 1.
Short title.
This Act may be cited as the
Health
5
Care Availability and Access Board Act.

6

Section 5.
Definitions.
In this Act:
7

"Biologic" means a drug that is produced or distributed in
8
accordance with a biologics license application approved under
9
42 U.S.C. 262(k)(3).
10

"Biosimilar" means a drug that is produced or distributed
11
in accordance with a biologics license application approved
12
under 42 U.S.C. 262(k)(3).
13

"Board" means the Health Care Availability and Access
14
Board.
15

"Brand name drug" means a drug that is produced or
16
distributed in accordance with an original new drug
17
application approved under 21 U.S.C. 355(c). "Brand name drug"
18
does not include an authorized generic drug as defined by 42
19
CFR 447.502.
20

"Council" means the Health Care Availability and Access
21
Stakeholder Council.
22

"Generic drug" means:
23

(1) a retail drug that is marketed or distributed in

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1

accordance with an abbreviated new drug application,
2

approved under 21 U.S.C. 355(j);
3

(2) an authorized generic drug as defined by 42 CFR
4

447.502; or
5

(3) a drug that entered the market before 1962 that
6

was not originally marketed under a new drug application.
7

"Manufacturer" means an entity that:
8

(1) owns the patent to a prescription drug product; or
9

(2) enters into a lease with another manufacturer to
10

market and distribute a prescription drug product under
11

the entity's own name;
12

(3) is the labeled entity of the generic product at
13

the point of manufacture; and
14

(4) sets or changes the wholesale acquisition cost of
15

the prescription drug product it manufactures or markets.
16

"Prescription drug product" means a brand name drug, a
17
generic drug, a biologic, or a biosimilar.

18

Section 10.
Health Care Availability and Access Board.
19

(a) There is established a Health Care Availability and
20
Access Board. The purpose of the Board is to protect State
21
residents, State and local governments, commercial health
22
plans, health care providers, pharmacies licensed in the
23
State, and other stakeholders within the health care system
24
from the high costs of prescription drug products. The Board
25
is a public body and is an instrumentality of the State. The

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Board is an independent unit of State government. The exercise
2
by the Board of its authority under this Act is an essential
3
function.
4

(b)(1) The 5 members of the Board and 3 alternate members
5
shall be appointed by the Governor with the advice and consent
6
of the Senate.
7

(2) The Board membership must include individuals with
8
demonstrated expertise in health care economics,
9
pharmaceutical markets, and clinical medicine. A member or an
10
alternate member may not be an employee of, a Board member of,
11
or a consultant to a manufacturer or trade association for
12
manufacturers.
13

(3) Any conflict of interest, including whether the
14
individual has an association, including a financial or
15
personal association, that has the potential to bias or has
16
the appearance of biasing an individual's decision in matters
17
related to the Board or the conduct of the Board's activities,
18
shall be considered and disclosed when appointing members and
19
alternate members to the Board.
20

(c) The term of a member or an alternate member is 5 years,
21
except that the terms of the initial members and alternate
22
members shall be staggered as required by the terms provided
23
for members in Section 55. Board members shall be appointed
24
within 90 days after the effective date of this Act. The Board
25
may begin its work regardless of a delay in appointments to the
26
Health Care Availability and Access Stakeholder Council

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1
created under Section 20.
2

(d) The Chair shall hire an executive director, general
3
counsel, and staff for the Board. Staff of the Board shall
4
receive a salary as provided in the budget of the Board. A
5
member of the Board: (i) may receive compensation as a member
6
of the Board; and (ii) is entitled to reimbursement for
7
expenses.
8

(e) A majority of the members of the Board shall
9
constitute a quorum for the purposes of conducting the
10
business of the Board.
11

(f) Subject to the requirements of this subsection, the
12
Board shall meet in open session at least 4 times per year to
13
review prescription drug product information. Information
14
concerning the location, date, and time of the meeting must be
15
made publicly available in accordance with the Open Meetings
16
Act. The Chair may cancel or postpone a meeting if there is no
17
business to conduct.
18

The Board shall perform the following actions in open
19
session: (i) deliberations on whether to subject a
20
prescription drug product to a cost review under subsection
21
(f) of Section 25; and (ii) any vote on whether to impose an
22
upper payment limit on purchases, payments, and payor
23
reimbursements of prescription drug products in the State. The
24
Board may otherwise meet in closed session to discuss
25
proprietary data and information.
26

The Board shall provide public notice of each Board

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1
meeting at least 3 weeks in advance of the meeting. Materials
2
for each Board meeting shall be made available to the public at
3
least 3 weeks in advance of the meeting. The Board shall
4
provide an opportunity for public comment at each open meeting
5
of the Board. The Board shall provide the public with the
6
opportunity to provide written comments on pending decisions
7
of the Board. The Board may allow expert testimony at Board
8
meetings, including when the Board meets in closed session.
9

(g)(1) Members of the Board shall recuse themselves from
10
decisions related to a prescription drug product if the
11
member, or an immediate family member of the member, has
12
received or could receive any of the following:
13

(A) a direct financial benefit of any amount deriving
14

from the result or finding of a study or determination by
15

or for the Board; or
16

(B) a financial benefit from any person who owns,
17

manufactures, or provides prescription drug products,
18

services, or items to be studied by the Board that in the
19

aggregate exceeds $5,000 per year.
20

As used in this paragraph, "financial benefit" includes
21
honoraria, fees, stock, the value of the member's or immediate
22
family member's stock holdings, and any direct financial
23
benefit deriving from the finding of a review conducted under
24
this Act.
25

(2) A disclosure of interests under this Section shall
26
include the type, nature, and magnitude of the interests of

SB0066
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LRB104 07474 BAB 17516 b
1
the member or his or her immediate family member involved.
2

(3) A conflict of interest shall be disclosed in advance
3
of the first open meeting after the conflict is identified or
4
within 5 days after the conflict is identified. A conflict of
5
interest shall be disclosed by:
6

(A) the Board when hiring Board staff;
7

(B) the appointing authority when appointing members
8

and alternate members to the Board and members to the
9

Council; and
10

(C) the Board when a member of the Board is recused in
11

any final decision resulting from a review of a
12

prescription drug product.
13

(4) A conflict of interest disclosed under this Section
14
shall be posted on the website of the Board unless the Chair of
15
the Board recuses the member from any final decision resulting
16
from a review of a prescription drug product.
17

(5) Members and alternate members of the Board, Board
18
staff, and third-party contractors may not accept any gift or
19
donation of services or property that indicates a potential
20
conflict of interest or has the appearance of biasing the work
21
of the Board.

22

Section 15.
Powers and duties of the Board.
In addition to
23
the powers set forth elsewhere in this Act, the Board may:
24

(1) adopt rules for the implementation of this Act;
25

and

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LRB104 07474 BAB 17516 b
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(2) enter into a contract with a qualified,
2

independent third party for any service necessary to carry
3

out the powers and duties of the Board.
4

Unless permission is granted by the Board, a third party
5
hired by the Board may not release, publish, or otherwise use
6
any information to which the third party has access under its
7
contract.

8

Section 20.
Health Care Availability and Access
9
Stakeholder Council.
10

(a) The Health Care Availability and Access Stakeholder
11
Council is created. The purpose of the Council is to provide
12
stakeholder input to assist the Board in making decisions as
13
required under this Act. The Council consists of 15 members
14
appointed within 90 days after the effective date of this Act
15
as follows:
16

(1) 3 members appointed by the Speaker of the House of
17

Representatives;
18

(2) 2 members appointed by the Minority Leader of the
19

House of Representatives;
20

(3) 3 members appointed by the President of the
21

Senate;
22

(4) 2 members appointed by the Minority Leader of the
23

Senate; and
24

(5) 5 members appointed by the Governor.
25

(b) The members of the Council shall have knowledge in one

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LRB104 07474 BAB 17516 b
1
or more of the following:
2

(1) the pharmaceutical business model;
3

(2) supply chain business models;
4

(3) the practice of medicine or clinical training;
5

(4) consumer or patient perspectives;
6

(5) clinical and health services research; or
7

(6) the State's health care marketplace.
8

(c) From among the membership of the Council, the Board
9
Chair shall appoint one member to be Council Chair.
10

(d) The term of a member is 3 years, except that the
11
initial members of the Council shall serve staggered terms as
12
required by the terms provided for members in Section 55.
13

(e) A member of the Council may not receive compensation
14
as a member of the Council, but is entitled to reimbursement
15
for travel expenses.

16

Section 25.
Drug cost affordability review.
17

(a) The Board shall limit its review of prescription drug
18
products to those that are:
19

(1) brand name drugs or biologics that, as adjusted
20

annually for inflation in accordance with the Consumer
21

Price Index, have:
22

(A) a wholesale acquisition cost of $60,000 or
23

more per year or course of treatment if less than a
24

year; or
25

(B) a wholesale acquisition cost increase of

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LRB104 07474 BAB 17516 b
1

$3,000 or more in any 12-month period;
2

(2) biosimilar drugs that have a wholesale acquisition
3

cost that is not at least 20% lower than the referenced
4

brand biologic at the time the biosimilars are launched,
5

and that have been suggested for review by the members of
6

public, medical professionals, and other stakeholders;
7

(3) generic drugs that, as adjusted annually for
8

inflation in accordance with the Consumer Price Index,
9

have a wholesale acquisition cost of at least $100 for a
10

30-day supply or course of treatment less than 30 days and
11

which increased by 200% or more during the immediately
12

preceding 12-month period, as determined by the difference
13

between the resulting wholesale acquisition cost and the
14

average of the wholesale acquisition cost reported over
15

the immediately preceding 12 months; and
16

(4) other prescription drug products that may create
17

affordability challenges for the State health care system
18

or patients, including, but not limited to, drugs to
19

address public health emergencies.
20

The Board is not required to identify every prescription
21
drug that meets the criteria of this subsection.
22

(b) The Board shall solicit public input on prescription
23
drugs thought to be creating affordability challenges that
24
meet the parameters of paragraphs (1) through (4) of
25
subsection (a). The Board shall determine whether to conduct a
26
full affordability review for the proposed prescription drugs

SB0066
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LRB104 07474 BAB 17516 b
1
after compiling preliminary information about the cost of the
2
product, patient cost sharing for the product, health plan
3
spending on the product, stakeholder input, and other
4
information decided by the Board.
5

(c) If the Board conducts a review of the cost and
6
affordability of a prescription drug product, the review shall
7
determine whether use of the prescription drug product that is
8
fully consistent with the labeling approved by the United
9
States Food and Drug Administration or standard medical
10
practice has led or will lead to affordability challenges for
11
the State health care system or high out-of-pocket costs for
12
patients.
13

(d) The information to conduct an affordability review may
14
include, but is not limited to, any document and research
15
related to the manufacturer's selection of the introductory
16
price or price increase of the prescription drug product,
17
patient assistance program or programs specific to the
18
product, estimated or actual manufacturer product price
19
concessions in the market, net product cost to State payers,
20
and other information as determined by the Board.
21

(e) Failure of a manufacturer to provide the Board with
22
the information for an affordability review does not affect
23
the authority of the Board to conduct such a review.
24

(f) If the Board finds that the spending on a prescription
25
drug product reviewed under this Section has led or will lead
26
to an affordability challenge, the Board shall establish an

SB0066
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LRB104 07474 BAB 17516 b
1
upper payment limit considering exceptional administrative
2
costs related to the distribution of the drug in the State.
3

(g) The upper payment limit applies to all purchases and
4
payor reimbursements of the prescription drug product intended
5
for use by individuals in the State, in person, by mail, or by
6
other means.
7

(h) Any information submitted to the Board in accordance
8
with this Section shall be subject to public inspection only
9
to the extent allowed under the Freedom of Information Act.
10

(i) This Section may not be construed to prevent a
11
manufacturer from marketing a prescription drug product
12
approved by the United States Food and Drug Administration
13
while the product is under review by the Board.

14

Section 30.
Protections and other Board considerations.
15

(a) The Board shall examine how an upper payment limit
16
would affect a covered entity, as that term is defined in
17
Section 340B of the federal Public Health Service Act.
18

(b) In determining whether a drug creates an affordability
19
challenge or determining an upper payment limit amount, the
20
Board may not use cost-effectiveness analyses that include the
21
cost-per-quality adjusted life year or a similar measure to
22
identify subpopulations for which a treatment would be less
23
cost-effective due to severity of illness, age, or preexisting
24
disability. In addition, for any treatment that extends life,
25
if the Board uses cost-effectiveness results, the Board must

SB0066
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1
use results that weigh the value of all additional lifetime
2
gained equally for all patients no matter their severity of
3
illness, age, or preexisting disability.
4

(c) An upper payment limit is effective no sooner than 6
5
months after it has been announced.
6

(d) State-regulated health plans shall inform the Board of
7
how any upper payment limit-related cost savings are directed
8
to the benefit of enrollees, with a priority on enrollee cost
9
sharing.
10

(e) The upper payment limit shall not be inclusive of the
11
pharmacy dispensing fee or provider administration fee.
12

(f) State licensed independent pharmacies may not be
13
reimbursed less than the upper payment limit.
14

(g) The Board shall adopt the Medicare Maximum Fair Price
15
as defined in 42 U.S.C. 1320f(c)(3) for a prescription drug as
16
the upper payment limit for that prescription drug product
17
intended for use by individuals in this State, per subsection
18
(g) of Section 25.
19

(h) The Board shall not create an upper payment limit that
20
is different from the Medicare Maximum Fair Price for the
21
prescription drug product that has a Medicare Maximum Fair
22
Price.
23

(i) The Board shall implement an upper payment limit that
24
is the same as the Medicare Maximum Fair Price no sooner than
25
the Medicare implementation date.
26

(j) Medicare Part C and D plans are not required to

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LRB104 07474 BAB 17516 b
1
reimburse at the upper payment limit.

2

Section 35.
Remedies.
The Attorney General may enforce
3
this Act. The Attorney General may pursue any available remedy
4
under State law when enforcing this Act.

5

Section 40.
Appeal of Board decisions.
6

(a) A person aggrieved by a decision of the Board may
7
request an appeal of the decision within 30 days after the
8
finding of the Board.
9

(b) The Board shall hear the appeal and make a final
10
decision within 60 days after the appeal is requested.
11

(c) Any person aggrieved by a final decision of the Board
12
may petition for judicial review in accordance with the
13
provisions of the Administrative Review Law.

14

Section 45.
Health Care Availability and Access Board
15
Fund.
The Health Care Availability and Access Board Fund is
16
created as a special fund in the State treasury. The Board
17
shall be funded by an annual assessment on all manufacturers
18
whose products are sold in the State. All funds collected by
19
the Board from the assessments shall be deposited into the
20
Fund. The Fund shall be used only to provide funding for the
21
Board and for the purposes authorized under this Act,
22
including any costs expended by any State agency to implement
23
this Act. All interest earned on moneys in the Fund shall be

SB0066
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LRB104 07474 BAB 17516 b
1
credited to the Fund. This Section may not be construed to
2
prohibit the Fund from receiving moneys from any other source
3
that does not create the appearance of a conflict of interest.
4
The Board shall be established using general funds, which
5
shall be repaid to the State with the assessments required
6
under this Section.

7

Section 50.
Reports.
8

(a) On or before December 31 of each year, the Board shall
9
submit to the General Assembly a report that includes:
10

(1) price trends for prescription drug products;
11

(2) the number of prescription drug products that were
12

subject to Board review, including the results of the
13

review and the number and disposition of appeals and
14

judicial reviews of Board decisions; and
15

(3) any recommendations the Board may have on further
16

legislation needed to make prescription drug products more
17

affordable in this State.
18

(b) On or before June 1, 2025, the Health Care
19
Availability and Access Board shall submit a report to the
20
General Assembly about the operation of the generic drug
21
market in the United States that includes a review of
22
physician-administered drugs and considers:
23

(1) the prices of generic drugs on a year-over-year
24

basis;
25

(2) the degree to which generic drug prices affect

SB0066
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1

insurance premiums as reported by health insurers in this
2

State or other states that collect this information;
3

(3) recent and current trends in patient cost sharing
4

for generic drugs;
5

(4) the causes and prevalence of generic drug
6

shortages; and
7

(5) any other relevant study questions.

8

Section 55.
Term expiration.
9

(a) The terms of the initial members and alternate members
10
of the Health Care Availability and Access Board shall expire
11
as follows:
12

(1) one member and one alternate member in 2029;
13

(2) 2 members and one alternate member in 2030; and
14

(3) 2 members, including the Chair of the Board, and
15

one alternate member in 2031.
16

(b) The terms of the initial members of the Health Care
17
Availability and Access Stakeholder Council shall expire as
18
follows:
19

(1) 5 members in 2029;
20

(2) 5 members in 2030; and
21

(3) 5 members in 2031.

22

Section 97.
Severability.
If any provision of this Act or
23
the application thereof to any person or circumstance is held
24
invalid for any reason in a court of competent jurisdiction,

SB0066
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1
the invalidity does not affect other provisions or any other
2
application of this Act that can be given effect without the
3
invalid provision or application, and for this purpose the
4
provisions of this Act are declared severable.

5

Section 900.
The State Finance Act is amended by adding
6
Section 5.1030 as follows:

7

(30 ILCS 105/5.1030 new)
8

Sec. 5.1030.
The Health Care Availability and Access Board
9
Fund.

10

Section 999.
Effective date.
This Act takes effect 180
11
days after becoming law.

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