HB 5804: MEDICAID-MCO RX PAYMENTS

Summary

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires a Medicaid managed care organization to reimburse a pharmacy provider that is not a critical access care pharmacy for dispensing fees and acquisition costs at no less than the amounts established under the fee-for-service program whether the Medicaid managed care organization directly reimburses those pharmacy providers or contracts with a pharmacy benefit manager to reimburse those pharmacy providers. Provides that the reimbursement requirement applies to all pharmacy services for persons receiving benefits under the Code including other specified pharmacy services.

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Jul 22, 2026

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