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HB 5514

Illinois House•In House Committee

Summary

HB 5514, “MEDICAID-PBM-PROCUREMENT”, was introduced in the House on Feb 6, 2026 by Rep. Nabeela Syed (D). It was referred to Rules, and last saw action on Feb 13, 2026: Referred to Rules Committee.

Record

Text

HB 5514 has no co-sponsors and has not gone to a roll call.

hb5514/introduced.txt
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Full Text of HB5514
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	HB5514 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5514
Introduced 2/13/2026, by Rep. Nabeela Syed
SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-36a new
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Chief Procurement Officer for General Services, in consultation with the Department of Healthcare and Family Services, to conduct and complete, no later than one year after the effective date of the amendatory Act, any procurement necessary to select a third-party administrator to serve as the single State pharmacy benefit manager for the medical assistance program and to be used by all Medicaid managed care organizations under contract with the Department. Provides that, beginning on January 1, 2028, the selected pharmacy benefit manager shall be responsible for managing and processing all pharmacy claims under the medical assistance program, including pharmacy claims from contracted Medicaid managed care organizations. Provides that the Department is responsible for enforcing the pharmacy benefit manager contract after the procurement process. Sets forth certain activities the Director of Healthcare and Family Services must do as part of the procurement process, including: (i) establishing eligibility criteria an entity must meet in order to become the State pharmacy benefit manager; and (ii) developing a master contract that incorporates all pharmacy benefit manager contract requirements under the Illinois Insurance Code, with some exceptions. Requires a prospective State pharmacy benefit manager to disclose certain information during the procurement process, including, but not limited to: (i) any conflicts of interest; (ii) any common ownership, board membership, or other control the pharmacy benefit manager has over a Medicaid managed care organization or other specified entities; and (iii) any financial terms and arrangements between the pharmacy benefit manager and a prescription drug manufacturer or labeler. Effective immediately.
LRB104 18694 KTG 32137 b
A BILL FOR
		HB5514		LRB104 18694 KTG 32137 b
    AN ACT concerning public aid.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Public Aid Code is amended by
adding Section 5-36a as follows:
    (305 ILCS 5/5-36a new)
    Sec. 5-36a. Pharmacy benefit manager; procurement.
    (a) No later than one year after the effective date of this 
amendatory Act of the 104th General Assembly, the Chief 
Procurement Officer for General Services, in consultation with 
the Department of Healthcare and Family Services, shall 
conduct and complete, in compliance with the Illinois 
Procurement Code, any procurement necessary to select a 
third-party administrator to serve as the single State 
pharmacy benefit manager for the medical assistance program 
and to be used by all Medicaid managed care organizations 
under contract with the Department. Beginning on January 1, 
2028, the selected pharmacy benefit manager shall be 
responsible for managing and processing all pharmacy claims 
under the medical assistance program, including pharmacy 
claims from contracted Medicaid managed care organizations. 
The Department of Healthcare and Family Services is 
responsible for enforcing the pharmacy benefit manager 
		HB5514	- 2 -	LRB104 18694 KTG 32137 b
contract after the procurement process.
    (b) As a part of the procurement process, the Director of 
the Department shall do all of the following:
        (1) Accept applications from entities seeking to 
    become the State pharmacy benefit manager.
        (2) Establish eligibility criteria an entity must meet 
    in order to become the State pharmacy benefit manager.
        (3) Select and contract with, in collaboration with 
    the Chief Procurement Officer for General Services, a 
    single State pharmacy benefit manager.
        (4) Develop a master contract that incorporates all 
    requirements under Article XXXIIB of the Illinois 
    Insurance Code, unless incorporating a particular 
    requirement would place the State in violation of federal 
    law or otherwise cause the State to lose eligibility for 
    federal payments.
    (c) A prospective State pharmacy benefit manager shall 
disclose to the Director all of the following during the 
procurement process:
        (1) Any activity, policy, practice, contract, or 
    arrangement of the pharmacy benefit manager that may 
    directly or indirectly present any conflict of interest 
    with the pharmacy benefit manager's relationship with or 
    obligation to the Department or a Medicaid managed care 
    organization.
        (2) All common ownership, members of a board of 
		HB5514	- 3 -	LRB104 18694 KTG 32137 b
    directors, managers, or other control of the pharmacy 
    benefit manager (or any of the pharmacy benefit manager's 
    affiliated companies) with any of the following:
            (A) A Medicaid managed care organization and its 
        affiliated companies.
            (B) An entity that contracts on behalf of a 
        pharmacy or any pharmacy services administration 
        organization and its affiliated companies.
            (C) A drug wholesaler or distributor and its 
        affiliated companies.
            (D) A third-party payer and its affiliated 
        companies.
            (E) A pharmacy and its affiliate companies.
        (3) Any direct or indirect fees, charges, or any kind 
    of assessments imposed by the pharmacy benefit manager on 
    pharmacies licensed in this State in which the pharmacy 
    benefit manager shares common ownership, management, or 
    control; or that are owned, managed, or controlled by any 
    of the pharmacy benefit manager's affiliated companies.
        (4) Any direct or indirect fees, charges, or any kind 
    of assessments imposed by the pharmacy benefit manager on 
    the pharmacies licensed in this State.
        (5) Any financial terms and arrangements between the 
    pharmacy benefit manager and a prescription drug 
    manufacturer or labeler, including formulary management, 
    drug substitution programs, educational support claims 
		HB5514	- 4 -	LRB104 18694 KTG 32137 b
    processing, or data sales fees.
    Section 99. Effective date. This Act takes effect upon
becoming law.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Chief Procurement Officer for General Services, in consultation with the Department of Healthcare and Family Services, to conduct and complete, no later than one year after the effective date of the amendatory Act, any procurement necessary to select a third-party administrator to serve as the single State pharmacy benefit manager for the medical assistance program and to be used by all Medicaid managed care organizations under contract with the Department. Provides that, beginning on January 1, 2028, the selected pharmacy benefit manager shall be responsible for managing and processing all pharmacy claims under the medical assistance program, including pharmacy claims from contracted Medicaid managed care organizations. Provides that the Department is responsible for enforcing the pharmacy benefit manager contract after the procurement process. Sets forth certain activities the Director of Healthcare and Family Services must do as part of the procurement process, including: (i) establishing eligibility criteria an entity must meet in order to become the State pharmacy benefit manager; and (ii) developing a master contract that incorporates all pharmacy benefit manager contract requirements under the Illinois Insurance Code, with some exceptions. Requires a prospective State pharmacy benefit manager to disclose certain information during the procurement process, including, but not limited to: (i) any conflicts of interest; (ii) any common ownership, board membership, or other control the pharmacy benefit manager has over a Medicaid managed care organization or other specified entities; and (iii) any financial terms and arrangements between the pharmacy benefit manager and a prescription drug manufacturer or labeler. Effective immediately.

Sponsors

Rep. Nabeela Syed (D) sponsors HB 5514 alone.

Nabeela Syed

Rep. · D–51 · Sponsor

Committees

HB 5514 went before 1 committee: Rules.

Rules
Rules
Referred to · Feb 13, 2026 · 5,290 Bills

History

HB 5514 has taken 3 actions since Feb 6, 2026, the latest on Feb 13, 2026.

ChamberAction
Feb 13, 2026
House
First Reading
Feb 13, 2026
House
Referred to Rules Committee
Feb 6, 2026
House
Filed with the Clerk by Rep. Nabeela Syed

Votes

HB 5514 has not gone to a roll call.

Source: ilga.gov · legiscan.com