101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3733
 
Introduced 2/14/2020, by Sen. Andy Manar
 
SYNOPSIS AS INTRODUCED:
 

 
  
215 ILCS 5/155.37

     Amends the Illinois Insurance Code. Provides that if a generic equivalent for a brand name drug is approved by the Food and Drug Administration, insurance companies with plans that provide coverage for prescription drugs through the use of a drug formulary that are amended, delivered, issued, or renewed in the State on or after January 1, 2021 shall immediately substitute the brand name drug with the generic equivalent or move the brand name drug to a formulary tier that reduces an enrollee's cost. Grants rulemaking authority to the Department of Insurance. Defines "brand name drug", "generic drug", and "formulary". Effective January 1, 2021.
  


LRB101 19166 BMS 68629 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
 
 
A BILL FOR
 

  
SB3733LRB101 19166 BMS 68629 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 Illinois Insurance Code is amended  by 
5changing Section 155.37 as follows:
 



6    (215 ILCS 5/155.37)



7    Sec. 155.37. Drug formulary; notice. 
8    (a)   As used in this Section:
9    "Brand name drug" means a prescription drug marketed under 
10a proprietary name or registered trademark name, including a 
11biological product.
12    "Generic drug" means a prescription drug, whether 
13identified by its chemical, proprietary, or nonproprietary 
14name, that is not a brand name drug and is therapeutically 
15equivalent to a brand name drug in dosage, safety, strength, 
16method of consumption, quality, performance, and intended use. 
17"Generic drug" includes a biosimilar product.
18    "Formulary" means a list of prescription drugs that is 
19developed by clinical and pharmacy experts and represents the 
20carrier's medically appropriate and cost-effective 
21prescription drugs approved for use. 
22    (b) Insurance
companies that transact the kinds of 
23insurance authorized under Class 1(b) or
Class 2(a) of Section 
 
 
SB3733- 2 -LRB101 19166 BMS 68629 b

14 of this Code and provide coverage for prescription
drugs 
2through the use of a drug formulary must notify insureds of any 
3change in
the formulary.  A company may comply with this Section 
4by posting changes in
the formulary on its website.

5    (c)   If a generic equivalent for a brand name drug is 
6approved by the Food and Drug Administration, insurance 
7companies with plans that provide coverage for prescription

8drugs through the use of a drug formulary that are amended, 
9delivered, issued, or renewed in this State on or after January 
101, 2021 shall:
11        (1)   immediately substitute the brand name drug with the 
12    generic equivalent; or
13        (2)   move the brand name drug to a formulary tier that 
14    reduces an enrollee's cost.
15    (d)   The Department of Insurance may adopt rules to 
16implement this Section. 
17(Source: P.A. 92-440, eff. 8-17-01; 92-651, eff. 7-11-02.)

 
 
18    Section 99. Effective date. This Act takes effect January 
191, 2021.