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| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3845 Introduced 2/22/2021, by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
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Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.
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| | A BILL FOR |
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| | HB3845 | | LRB102 14127 BMS 19479 b |
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| 1 | | AN ACT concerning regulation.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Insurance Code is amended by |
| 5 | | adding Section 356z.43 as follows:
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| 6 | | (215 ILCS 5/356z.43 new) |
| 7 | | Sec. 356z.43. Genetic, rare, and unique conditions; |
| 8 | | medically necessary treatment. |
| 9 | | (a) An insurance policy amended, delivered, issued, or |
| 10 | | renewed in this State on or after the effective date of this |
| 11 | | amendatory Act of the 102nd General Assembly shall provide |
| 12 | | coverage for medically necessary treatments for genetic, rare, |
| 13 | | unknown or unnamed, and unique conditions, including |
| 14 | | Ehlers-Danlos syndrome and altered drug metabolism. |
| 15 | | (b) For an insurance policy that provides coverage for |
| 16 | | prescription drugs, the coverage required under subsection (a) |
| 17 | | shall include coverage for opioid alternatives, coverage for |
| 18 | | medicines included in the most recent Model List of Essential |
| 19 | | Medicines published by the World Health Organization, and |
| 20 | | coverage for custom-made medications and medical food. |
| 21 | | (c) An insurance policy that limits the quantity of a |
| 22 | | medication in accordance with applicable State and federal law |
| 23 | | shall not require pre-approval for the treatment of patients |