HB1745 EnrolledLRB102 14220 BMS 19572 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, beginning 
9January 1, 2023, every health insurance carrier that offers an 
10individual health plan that provides coverage for prescription 
11drugs shall ensure that at least 10% of individual health care 
12plans offered in each applicable service area and at each 
13level of coverage as defined in 42 U.S.C. 18022 apply a 
14flat-dollar copayment structure to the entire drug benefit. 
15Beginning January 1, 2024, every health insurance carrier that 
16offers an individual health plan that provides coverage for 
17prescription drugs shall ensure that at least 25% of 
18individual health care plans offered in each applicable 
19service area and at each level of coverage as defined in 42 
20U.S.C. 18022 apply a flat-dollar copayment structure to the 
21entire drug benefit. If a health insurance carrier offers 
22fewer than 4 plans in a service area, then the health insurance 
23carrier shall ensure that one plan applies a flat-dollar 
 
 
HB1745 Enrolled- 2 -LRB102 14220 BMS 19572 b

1copayment structure to the entire drug benefit. 
2    (b)   Beginning January 1, 2023, every health insurance 
3carrier that offers a group health plan that provides coverage 
4for prescription drugs shall offer at least one group health 
5plan in each applicable service area and at each level of 
6coverage as defined in 42 U.S.C. 18022 that applies a 
7flat-dollar copayment structure to the entire drug benefit.  
8Beginning January 1, 2024, every health insurance carrier that 
9offers a group health plan that provides coverage for 
10prescription drugs shall offer at least 2 group health plans 
11in each applicable service area and at each level of coverage 
12as defined in 42 U.S.C. 18022 that apply a flat-dollar 
13copayment structure to the entire drug benefit.
14    (c)   The flat-dollar copayment structure for prescription 
15drugs under subsections (a) and (b) must be applied 
16pre-deductible and be reasonably graduated and proportionately 
17related in all tier levels such that the copayment structure 
18as a whole does not discriminate against or discourage the 
19enrollment of individuals with significant health care needs. 
20    (d) A health insurance carrier that offers individual or 
21group health care plans shall clearly and appropriately name 
22the plans described in subsections (a) and (b)   to aid in the 
23individual or group plan selection process. 
24    (e) A health insurance carrier shall market plans 
25described in subsections (a) and (b) in the same manner as 
26plans not described in subsections (a) and (b). 
 
 
HB1745 Enrolled- 3 -LRB102 14220 BMS 19572 b

1    (f) The Department shall adopt rules necessary to 
2implement and enforce the provisions of this Section. 
 
 
3    Section 99. Effective date. This Act takes effect January 
41, 2023.