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1 | AMENDMENT TO HOUSE BILL 3638
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2 | AMENDMENT NO. ______. Amend House Bill 3638 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | adding Section 364.3 as follows: | ||||||
6 | (215 ILCS 5/364.3 new) | ||||||
7 | Sec. 364.3. Prior authorization
form; prescription | ||||||
8 | benefits. | ||||||
9 | (a) Notwithstanding any other provision of law, on and | ||||||
10 | after January 1, 2015, a health insurer that provides | ||||||
11 | prescription drug benefits must, within 72 hours after receipt | ||||||
12 | of a paper or electronic prior authorization form from a | ||||||
13 | prescribing provider or pharmacist, either approve or deny the | ||||||
14 | prior authorization. In the case of a denial, the health | ||||||
15 | insurer shall provide the prescriber with the reason for the | ||||||
16 | denial, an alternative covered medication, if applicable, and |
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1 | information regarding the procedure for submitting an appeal to | ||||||
2 | the denial. | ||||||
3 | In the case of an expedited coverage determination, the | ||||||
4 | health insurer must either approve or deny the prior | ||||||
5 | authorization within 24 hours after receipt of the paper or | ||||||
6 | electronic prior authorization form. In the case of a denial, | ||||||
7 | the health insurer shall provide the prescriber with the reason | ||||||
8 | for the denial, an alternative covered medication, if | ||||||
9 | applicable, and information regarding the procedure for | ||||||
10 | submitting an appeal to the denial. | ||||||
11 | (b) This Section does not apply to plans for beneficiaries | ||||||
12 | of Medicare or Medicaid. | ||||||
13 | (c) For the purposes of this Section: | ||||||
14 | "Pharmacist" has the same meaning as set forth in the | ||||||
15 | Pharmacy Practice Act. | ||||||
16 | "Prescribing provider" includes a provider authorized to | ||||||
17 | write a prescription, as described in subsection (e) of Section | ||||||
18 | 3 of the Pharmacy Practice Act,
to treat a medical condition of | ||||||
19 | an insured.
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20 | Section 99. Effective date. This Act takes effect upon | ||||||
21 | becoming law.".
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