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Rep. Greg Harris
Filed: 3/19/2021
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| 1 | | AMENDMENT TO HOUSE BILL 1745
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| 2 | | AMENDMENT NO. ______. Amend House Bill 1745 by replacing |
| 3 | | everything after the enacting clause with the following:
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| 4 | | "Section 5. The Managed Care Reform and Patient Rights Act |
| 5 | | is amended by adding Section 45.3 as follows:
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| 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 |
| 9 | | January 1, 2023, every health insurance carrier that offers an |
| 10 | | individual health plan that provides coverage for prescription |
| 11 | | drugs shall ensure that at least 10% of individual health care |
| 12 | | plans offered in each applicable service area and at each |
| 13 | | level of coverage as defined in 42 U.S.C. 18022 apply a |
| 14 | | flat-dollar copayment structure to the entire drug benefit. |
| 15 | | Beginning January 1, 2024, every health insurance carrier that |
| 16 | | offers an individual health plan that provides coverage for |
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| 1 | | prescription drugs shall ensure that at least 25% of |
| 2 | | individual health care plans offered in each applicable |
| 3 | | service area and at each level of coverage as defined in 42 |
| 4 | | U.S.C. 18022 apply a flat-dollar copayment structure to the |
| 5 | | entire drug benefit. If a health insurance carrier offers |
| 6 | | fewer than 4 plans in a service area, then the health insurance |
| 7 | | carrier shall ensure that one plan applies a flat-dollar |
| 8 | | copayment structure to the entire drug benefit. |
| 9 | | (b) Beginning January 1, 2023, every health insurance |
| 10 | | carrier that offers a group health plan that provides coverage |
| 11 | | for prescription drugs shall offer at least one group health |
| 12 | | plan in each applicable service area and at each level of |
| 13 | | coverage as defined in 42 U.S.C. 18022 that applies a |
| 14 | | flat-dollar copayment structure to the entire drug benefit. |
| 15 | | Beginning January 1, 2024, every health insurance carrier that |
| 16 | | offers a group health plan that provides coverage for |
| 17 | | prescription drugs shall offer at least 2 group health plans |
| 18 | | in each applicable service area and at each level of coverage |
| 19 | | as defined in 42 U.S.C. 18022 that apply a flat-dollar |
| 20 | | copayment structure to the entire drug benefit. |
| 21 | | (c) The flat-dollar copayment structure for prescription |
| 22 | | drugs under subsections (a) and (b) must be applied |
| 23 | | pre-deductible and be reasonably graduated and proportionately |
| 24 | | related in all tier levels such that the copayment structure |
| 25 | | as a whole does not discriminate against or discourage the |
| 26 | | enrollment of individuals with significant health care needs. |
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| 1 | | (d) A health insurance carrier that offers individual or |
| 2 | | group health care plans shall clearly and appropriately name |
| 3 | | the plans described in subsections (a) and (b) to aid in the |
| 4 | | individual or group plan selection process. |
| 5 | | (e) A health insurance carrier shall market plans |
| 6 | | described in subsections (a) and (b) in the same manner as |
| 7 | | plans not described in subsections (a) and (b). |
| 8 | | (f) The Department shall adopt rules necessary to |
| 9 | | implement and enforce the provisions of this Section.
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| 10 | | Section 99. Effective date. This Act takes effect January |
| 11 | | 1, 2023.".
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