Illinois General Assembly - Full Text of HB1466
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Full Text of HB1466  102nd General Assembly


Rep. Will Guzzardi

Filed: 4/4/2022





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2    AMENDMENT NO. ______. Amend House Bill 1466 by replacing
3everything after the enacting clause with the following:
4    "Section 1. Short title. This Act may be cited as the
5Access to Affordable Insulin Act.
6    Section 5. Definitions. As used in this Act:
7    "Department" means the Department of Public Health.
8    "Insulin" means a prescription drug that contains insulin.
9    "Manufacturer" means a manufacturer engaged in the
10manufacturing of insulin that is self-administered on an
11outpatient basis.
12    "Navigator" has the meaning described in Section 1311(i)
13of the Patient Protection and Affordable Care Act, Public Law
14111-148, and further defined through amendments to that Act
15and regulations issued under that Act.
16    "Pharmacy" means a pharmacy located in this State.



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1    "Prescription drug" means a drug that is required by
2federal or State law or rule to be dispensed only by
3prescription or that is restricted to administration only by
5    "Urgent need of insulin" means having readily available
6for use less than a 7-day supply of insulin and in need of
7insulin in order to avoid the likelihood of suffering
8significant health consequences.
9    Section 10. Insulin urgent-need program.
10    (a) To be eligible to receive an urgent-need supply of
11insulin under this Section, an individual must attest to:
12        (1) being a resident of this State;
13        (2) not being enrolled in a medical assistance program
14    under the Illinois Public Aid Code;
15        (3) not being enrolled in prescription drug coverage
16    that limits the total amount of cost sharing that the
17    enrollee is required to pay for a 30-day supply of
18    insulin, including copayments, deductibles, or
19    coinsurance, to $35 or less, regardless of the type or
20    amount of insulin prescribed;
21        (4) not having received an urgent-need supply of
22    insulin through this program within the previous 12
23    months, unless authorized under subsection (m) or (n); and
24        (5) being in urgent need of insulin.
25    (b) The Department shall develop an application form to be



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1used by an individual who is in urgent need of insulin. The
2application must ask the individual to attest to the
3eligibility requirements described in subsection (a). The form
4shall be accessible through the Department's website. The
5Department shall also make the form available to pharmacies
6and health care providers who prescribe or dispense insulin,
7hospital emergency departments, urgent care clinics, and
8community health clinics. By submitting a completed, signed,
9and dated application to a pharmacy, the individual attests
10that the information contained in the application is correct.
11    (c) If an individual is in urgent need of insulin, the
12individual may present a completed, signed, and dated
13application form to a pharmacy. The individual must also:
14        (1) have a valid insulin prescription; and
15        (2) present the pharmacist with identification
16    indicating Illinois residency in the form of a valid
17    Illinois identification card, driver's license, or permit;
18    if the individual in urgent need of insulin is under the
19    age of 18, the individual's parent or legal guardian must
20    provide the pharmacist with proof of residency.
21    (d) Upon receipt of a completed and signed application, a
22pharmacist shall dispense the prescribed insulin in an amount
23that will provide the individual with a 30-day supply. The
24pharmacy shall notify the health care practitioner who issued
25the prescription order no later than 72 hours after the
26insulin is dispensed.



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1    (e) A pharmacy may submit to the manufacturer of the
2dispensed insulin product or to the manufacturer's vendor a
3claim for payment that is in accordance with the National
4Council for Prescription Drug Program standards for electronic
5claims processing, unless the manufacturer agrees to send to
6the pharmacy a replacement supply of the same insulin as
7dispensed in the amount dispensed. If the pharmacy submits an
8electronic claim to the manufacturer or the manufacturer's
9vendor, the manufacturer or vendor shall reimburse the
10pharmacy in an amount that covers the pharmacy's acquisition
12    (f) A pharmacy may collect an insulin copayment from an
13individual to cover the pharmacy's costs of processing and
14dispensing in an amount not to exceed $35 for the 30-day supply
15of insulin dispensed.
16    (g) The pharmacy shall also provide each eligible
17individual with the information sheet described in subsection
18(i) and a list of trained navigators provided by the
19Department for the individual to contact if the individual is
20in need of accessing ongoing insulin coverage options,
21including assistance in:
22        (1) applying for medical assistance;
23        (2) applying for a qualified health plan, subject to
24    open and special enrollment periods;
25        (3) accessing information on providers who participate
26    in prescription drug discount programs, including



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1    providers who are authorized to participate in the 340B
2    program under Section 340b of the Public Health Services
3    Act, Section 256b of Title 42 of the United States Code;
4    and
5        (4) accessing insulin manufacturers' copayment
6    assistance programs and other foundation-based programs.
7    (h) A pharmacist shall retain a copy of the application
8form submitted by the individual to the pharmacy for reporting
9and auditing purposes.
10    (i) The Department shall develop an information sheet to
11post on its website and provide a link to the information sheet
12on the board's website for pharmacies, health care
13practitioners, hospital emergency departments, urgent care
14clinics, and community health clinics. The information sheet
15shall contain:
16        (1) a description of the urgent-need insulin program,
17    including how to access the program;
18        (2) a description of each insulin manufacturer's
19    cost-sharing assistance program, including contact
20    information on accessing the assistance program for each
21    manufacturer;
22        (3) information on how to contact a trained navigator
23    for assistance in applying for medical assistance or a
24    qualified health plan; and
25        (4) notification that an individual in need of
26    assistance may contact the individual's local county



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1    social service department for more information or
2    assistance in accessing ongoing affordable insulin
3    options.
4    (j) The Department shall also inform each individual who
5accesses urgent-need insulin under this Section that the
6individual may participate in a survey conducted by the
7Department regarding satisfaction with the program. The
8Department shall provide contact information for the
9individual to learn more about the survey and how to
10participate. This information may be included on the
11information sheet described in subsection (i).
12    (k) The Department shall develop a training program for
13navigators to provide navigators with information and
14resources necessary to assist individuals in accessing
15appropriate long-term insulin options.
16    (l) The Department shall compile a list of navigators who
17have completed the training program and who are available to
18assist individuals in accessing affordable insulin coverage
19options. The list shall be made available through the
20Department's website and to pharmacies and health care
21practitioners who dispense and prescribe insulin.
22    (m) If an individual has applied for the medical
23assistance program under the Illinois Public Aid Code but has
24not been determined eligible or has been determined eligible
25but coverage has not become effective, the individual may
26access urgent-need insulin if the individual is in urgent need



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1of insulin as defined in Section 5.
2    (n) To access an additional 30-day supply of insulin, an
3individual must attest to the pharmacy that the individual
4meets the requirements of subsection (m) and must comply with
5subsection (c).
6    Section 90. The Illinois Insurance Code is amended by
7changing Section 356z.41 as follows:
8    (215 ILCS 5/356z.41)
9    Sec. 356z.41. Cost sharing in prescription insulin drugs;
10limits; confidentiality of rebate information.
11    (a) As used in this Section, "prescription insulin drug"
12means a prescription drug that contains insulin and is used to
13control blood glucose levels to treat diabetes but does not
14include an insulin drug that is administered to a patient
16    (b) This Section applies to a group or individual policy
17of accident and health insurance amended, delivered, issued,
18or renewed on or after the effective date of this amendatory
19Act of the 101st General Assembly.
20    (c) An insurer that provides coverage for prescription
21insulin drugs pursuant to the terms of a health coverage plan
22the insurer offers shall limit the total amount that an
23insured is required to pay for a 30-day supply of covered
24prescription insulin drugs at an amount not to exceed $35



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1$100, regardless of the quantity or type of covered
2prescription insulin drug used to fill the insured's
4    (d) Nothing in this Section prevents an insurer from
5reducing an insured's cost sharing by an amount greater than
6the amount specified in subsection (c).
7    (e) The Director may use any of the Director's enforcement
8powers to obtain an insurer's compliance with this Section.
9    (f) The Department may adopt rules as necessary to
10implement and administer this Section and to align it with
11federal requirements.
12    (g) On January 1 of each year, the limit on the amount that
13an insured is required to pay for a 30-day supply of a covered
14prescription insulin drug shall increase by a percentage equal
15to the percentage change from the preceding year in the
16medical care component of the Consumer Price Index of the
17Bureau of Labor Statistics of the United States Department of
19(Source: P.A. 101-625, eff. 1-1-21.)
20    Section 99. Effective date. This Act takes effect upon
21becoming law.".