101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4477
 
Introduced 2/4/2020, by Rep. Gregory Harris
 
SYNOPSIS AS INTRODUCED:
 

 
215 ILCS 134/45.3 new

     Amends the Managed Care Reform and Patient Rights Act. Requires health insurance carriers that provide coverage for prescription drugs to ensure that, within service areas and levels of coverage specified by federal law, at least half of individual and group plans meet one or more of the following criteria: apply a pre-deductible and flat-dollar copayment structure to the entire drug benefit, limit a beneficiary's monthly out-of-pocket financial responsibility for prescription drugs to a specified amount, or limit a beneficiary's annual out-of-pocket financial responsibility for prescription drugs to a specified amount. Provides that all plans for prescription drugs offered under the amendatory Act must be clearly and appropriately named, marketed in the same manner as other plans offered by the health insurance carrier, and offered for purchase to any individual and group plan sponsor. Effective January 1, 2021.
  


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A BILL FOR
 

  
HB4477LRB101 18735 BMS 68190 b


  
1    AN ACT concerning regulation.
  
 
2    Be it enacted by the People of the State of Illinois,
 
3represented in the General Assembly:
  
 
 
4    Section 5. The Managed Care Reform and Patient Rights Act 
5is amended  by adding Section 45.3 as follows:
 
6    (215 ILCS 134/45.3 new)
7    Sec. 45.3. Prescription drug benefits; plan choice.
8    (a)     Notwithstanding any other provision of law, on and 
9after January 1, 2021, every health insurance carrier that 
10provides coverage for prescription drugs shall ensure that no 
11fewer than 50% of individual and group plans offered within 
12each service area and at each level of coverage as defined in 
1342 U.S.C. 18022, if applicable, that are delivered, issued for 
14delivery, renewed, amended, or continued by the health 
15insurance carrier meet one or more of the following criteria:
16        (1) apply a pre-deductible and flat-dollar copayment 
17    structure to the entire drug benefit, including all tiers; 
18    the flat-dollar copayment tier structure for prescription 
19    drugs under this Section must be graduated and 
20    proportionate;
21        (2) limit a beneficiary's monthly out-of-pocket 
22    financial responsibility, including any copayment or 
23    coinsurance, for prescription drugs, including specialty 
 
 
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1    drugs, to no more than $150 per month for each prescription 
2    drug for up to a 30-day supply of any single drug; the 
3    out-of-pocket limit established under this Section shall 
4    apply pre-deductible, if applicable; or
5        (3) limit a beneficiary's annual out-of-pocket 
6    financial responsibility for prescription drugs, including 
7    specialty drugs, to no more than the minimum per year 
8    dollar amounts in effect under Section 223(c)(2)(A)(i) of 
9    the Internal Revenue Code for self-only coverage.
10    (b)     All plans offered pursuant to this Section shall be:
11        (1)   clearly and appropriately named to aid in the 
12    consumer or plan-sponsor plan selection process;
13        (2)   marketed in the same manner as other plans offered 
14    by the health insurance carrier; and
15        (3)   offered for purchase to any individual and group 
16    plan sponsor.
17    (c)     The Department shall adopt rules necessary to implement 
18and enforce this Section.
 
 
19    Section 99. Effective date. This Act takes effect January 
201, 2021.