Illinois legislation · 104th General Assembly
Illinois HB5804: MEDICAID-MCO RX PAYMENTS
Status: Introduced, September 4, 2026
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.
What the bill says
A bill FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026HB5804Introduced , by Rep. Dave VellaSYNOPSIS AS INTRODUCED: ILCS 5/5-5.12from Ch. 23, par. 5-5.12 305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12 Amends the Medical Assistance Article of the Illinois Public AidCode…
From the introduced text, July 22, 2026:
A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026HB5804Introduced , by Rep. Dave VellaSYNOPSIS AS INTRODUCED: ILCS 5/5-5.12from Ch. 23, par. 5-5.12 305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12 Amends the Medical Assistance Article of the Illinois Public AidCode. Requires a Medicaid managed care organization to reimburse apharmacy provider that is not a critical access care pharmacy fordispensing fees and acquisition costs at no less than the amountsestablished under the fee-for-service program whether the Medicaid managedcare organization directly reimburses those pharmacy providers orcontracts with a pharmacy benefit manager to reimburse those pharmacyproviders. Provides that the reimbursement requirement applies to allpharmacy services for persons receiving benefits under the Code includingother specified pharmacy services. LRB104 22340 KTG 38782 b LRB104 22340 KTG 38782 b LRB104 22340 KTG 38782 b A BILL FOR HB5804LRB104 22340 KTG 38782 b HB5804 LRB104 22340 KTG 38782 b HB5804 LRB104 22340 KTG 38782 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 changing Section 5-5.12 as follows: (305 ILCS 5/5-5.12)(from Ch. 23, par. 5-5.12) Sec. 5-5.12.Pharmacy payments. (a) Every request submitted by a pharmacy for reimbursement under this Article for prescription drugs provided to …
Sponsors
- Dave Vella (D, 68) · primary sponsor
- Maurice West (D, 67)
- Theresa Mah (D, 24)
Latest actions
- : Added Co-Sponsor Rep. Theresa Mah
- : Added Co-Sponsor Rep. Maurice A. West, II
- : Filed with the Clerk by Rep. Dave Vella
Common questions
- What is HB5804?
- HB5804 is a bill in the Illinois Legislature (104th General Assembly): MEDICAID-MCO RX PAYMENTS.
- What does HB5804 do?
- In its own words: A bill FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026HB5804Introduced , by Rep. Dave VellaSYNOPSIS AS INTRODUCED: ILCS 5/5-5.12from Ch. 23, par. 5-5.12 305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12 Amends the Medical Assistance Article of the Illinois Public AidCode…
- What is the status of HB5804?
- Introduced as of September 4, 2026. Latest action: Added Co-Sponsor Rep. Theresa Mah (September 4, 2026).
- Who sponsored HB5804?
- Dave Vella (D, 68), with 2 co-sponsors.
- Where is the official record for HB5804?
- On the Illinois Legislature website: https://www.ilga.gov/Legislation/BillStatus?DocNum=5804&GAID=18&DocTypeID=HB&SessionID=114
Source: official Illinois record. Tracked by Delilah, AI for legislation across all 50 states and Congress.