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| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB5865 Introduced 11/12/2024, by Rep. Harry Benton SYNOPSIS AS INTRODUCED:
| | | Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2025 that provides coverage for prescription drugs shall require that a covered individual's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 100% of all rebates received in connection with the dispensation or administration of the prescription drug. Provides that an insurer shall apply any rebate amount in excess of the defined cost sharing amount to the health plan to reduce premiums. Provides that the provisions shall not preclude an insurer from decreasing a covered individual's defined cost sharing by an amount greater than the stated amount at the point of sale. Provides that the Department of Insurance may adopt rules to implement the provisions. |
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| | A BILL FOR |
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| | HB5865 | | LRB103 41564 RPS 74783 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, |
| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Insurance Code is amended by |
| 5 | | adding Section 356z.72 as follows:
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| 6 | | (215 ILCS 5/356z.72 new) |
| 7 | | Sec. 356z.72. Cost sharing; prescription rebates. |
| 8 | | (a) A group or individual policy of accident and health |
| 9 | | insurance amended, delivered, issued, or renewed on or after |
| 10 | | January 1, 2025 that provides coverage for prescription drugs |
| 11 | | shall require that a covered individual's defined cost sharing |
| 12 | | for each prescription drug shall be calculated at the point of |
| 13 | | sale based on a price that is reduced by an amount equal to at |
| 14 | | least 100% of all rebates received in connection with the |
| 15 | | dispensation or administration of the prescription drug. |
| 16 | | (b) An insurer shall apply any rebate amount in excess of |
| 17 | | the defined cost sharing amount to the health plan to reduce |
| 18 | | premiums. |
| 19 | | (c) Nothing in this Section shall preclude an insurer from |
| 20 | | decreasing a covered individual's defined cost sharing by an |
| 21 | | amount greater than the stated amount at the point of sale. |
| 22 | | (d) The Department may adopt rules to implement this |
| 23 | | Section. |