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215 Ill. Comp. Stat. § 134/45.1. Medical exceptions procedures required: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2014
Notwithstanding any other provision of law, on or after the effective date of this amendatory Act of the 99th General Assembly, every insurer licensed in this State to sell a policy of group or individual …
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215 Ill. Comp. Stat. § 134/45.2. Prior authorization form; prescription benefits: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2014
A health insurer that provides prescription drug benefits must, within 72 hours after receipt of a paper or electronic prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization. …
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215 Ill. Comp. Stat. § 134/72. Pharmacy providers: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2000
A health care plan shall apply the same co-insurance, copayment, and deductible factors to all drug prescriptions filled by a pharmacy provider that participates in the health care plan’s network. A health care plan may …
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215 Ill. Comp. Stat. § 5/356x.25 – Illinois
Status: Enacted    
Provides that every policy of accident and health insurance amended, delivered, issued, or renewed after the effective date of the amendatory Act that provides coverage for prescription drugs shall provide for synchronization of prescription drug …

215 Ill. Comp. Stat. § 5/370c. Mental and emotional disorders: Accident and Health Insurance – Illinois
Status: Enacted     Year Enacted: 1977
Plans shall shall provide coverage based upon medical necessity for the treatment of a mental, emotional, nervous, or substance use disorder or condition in parity with physical treatments. Plans shall not impose additional prior authorization …
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215 Ill. Comp. Stat. §§ 180/1 through 180/42: Health Carrier External Review Act – Illinois
Status: Enacted     Year Enacted: 2010
The Health Carrier External Review Act’s purpose is to provide uniform standards for the establishment and maintenance of external review procedures. Statutes set out timeline and process for a standard review.
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30 Ill. Comp. Stat. § 105/14c. Prescription drug benefits: State Finance Act – Illinois
Status: Enacted     Year Enacted: 2004
No appropriation may be expended for prescription drug benefits under the State Employees Group Insurance Act of 1971 unless the benefit program allows all prescription drug benefits to be provided on the same terms and …
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305 Ill. Comp. Stat. § 5/5-30.3. Empowering meaningful patient choice in Medicaid Managed Care: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 2016
Each medicaid managed care entity shall have an updated provider directory. Medicaid Managed Care Entities shall publish on their respective websites a formulary for each plan offered and make the formularies easily understandable and publicly …
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305 Ill. Comp. Stat. § 5/5-4.1. Co-payments: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 1981
Co-payments are permissible for most health care services, but not for chronic illness treatment. There is a $2 co-pay for generic drugs.
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305 Ill. Comp. Stat. § 5/5-5.12. Pharmacy payments: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 1984
Pharmacies providing prescription drugs under this Article shall be reimbursed at a rate which shall include a professional dispensing fee as determined by the Illinois Department, plus the current acquisition cost of the prescription drug …
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305 Ill. Comp. Stat. § 5/5-5.12a. Title XIX waiver; pharmacy assistance program: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 2001
The Illinois Department may seek a waiver of otherwise applicable requirements of Title XIX of the federal Social Security Act1 in order to claim federal financial participation for a pharmacy assistance program for persons aged …
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35 Pa. Stat. and Cons. Stat. Ann. §§ 960.1 through 960.7: Generic Equivalent Drug Law – Pennsylvania
Status: Enacted     Year Enacted: 1976
It is the purpose of this act to permit consumers to secure necessary drugs at the most economical cost consistent with the professional discretion of the purchaser’s physician and pharmacist.
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40 Pa. Stat. and Pa. Cons. Stat. §§ 4501 through 4503, 4531 through 4535, 4551 through 4562: Pharmacy Audit Integrity and Transparency Act – Pennsylvania
Status: Enacted     Year Enacted: 2016
Governs PBM cost transparency requirements.
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5 Ill. Comp. Stat. § 375/6.4. Prescription drugs; cancer treatment: State Employees Group Insurance Act of 1971 – Illinois
Status: Enacted     Year Enacted: 1993
If the program of health benefits provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer, it may not exclude coverage of any drug …
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5 R.I. Gen. Laws § 5-19.1-30. List of drugs to be posted — Display of current selling price required — Exception: Pharmacies – Rhode Island
Status: Enacted     Year Enacted: 2001
The director of the department of health shall compile a list of at least ten (10) prescribed health maintenance drugs and forward it to the board of pharmacy which shall distribute that list to all …
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63 Pa. Cons. Stat. § 390-8. Unlawful acts: Pharmacy Acts – Pennsylvania
Status: Enacted     Year Enacted: 1961
It shall be unlawful for any pharmacist to dispense an emergency prescription, unless the pharmacist does the specified. For example, the pharmacist must first attempt to obtain an authorization from the authorized prescriber and cannot …
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