Illinois’ new Healthcare Protection Act (HPA) includes a first-in-the-nation banning of step therapy for covered services, a provision that health policy experts expect could be copied by other states.
Looming Step Therapy Ban In Illinois Is ‘Game Changer,’ Could Start Trend
Federal legislation on PBM reforms has stalled, but state efforts remain active. Illinois’ Healthcare Protection Act includes several other limits on insurer power, including prohibiting prior authorization for inpatient mental health care.

More from PBMs
An analysis of Medicare Part D and other data found that more than one-third of all pharmacy spending went through pharmacies owned by Cigna, CVS Health, Humana or UnitedHealth Group.
The leader of the House Energy and Commerce Health Subcommittee has a plan for passing pharmacy benefit manager reforms, but Democrats are skeptical.
The pharmaceutical industry has been quiet on Trump's early federal government overhauls that could harm the drug business, still betting he will help produce better results than Biden.
Chairman-designee Andrew Ferguson likely will continue the commission’s investigation of PBMs during the next administration.
More from Market Access
Cell and gene therapy manufacturers must consider the practicalities of their product within the context of a health care system before it comes onto the market to be successful, experts from Novartis, AstraZeneca and England’s National Health Service say.
Democrats opposed the nomination because they believe Mehmet Oz will not defend Medicaid from spending cuts. His pledge to continue lowering drug costs in Medicare and Medicaid did not offset the concerns.
An analysis of Medicare Part D and other data found that more than one-third of all pharmacy spending went through pharmacies owned by Cigna, CVS Health, Humana or UnitedHealth Group.