Illinois General Assembly - Full Text of SR1539
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Full Text of SR1539  99th General Assembly




SR1539LRB099 17248 MST 44641 r


2    WHEREAS, Patients, especially those with serious or
3chronic conditions, should be able to continue the course of
4therapy recommended by their physician; and
5    WHEREAS, Health plans and pharmacy benefit managers (PBMs)
6have implemented policies called "non-medical switching" that
7require patients to switch to cheaper, insurer-preferred
8drugs; these policies include making formulary changes that
9limit or restrict access to certain treatments and increasing
10out-of-pocket costs; and
11    WHEREAS, A stable patient should not be required to switch
12treatments simply due to payer cost controls; and
13    WHEREAS, Studies have shown that patients with chronic
14conditions, who have been stabilized on drug therapy and then
15switched to another drug, face negative consequences, such as
16allergic reaction or lack of response; and
17    WHEREAS, Nearly all health plans and PBMs in the United
18States switch patients between drugs as part of a utilization
19management program offered to employers and other customers,
20including states; and



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1    WHEREAS, Switching a stable patient for non-medical
2reasons may be dangerous, is usually unnecessary, and rarely
3generates overall cost savings; and
4    WHEREAS, Out-of-pocket costs for patients can exceed 30% of
5the costs of primary care, specialist visits, and some
6medications, while average deductibles have increased by 150%
7over the past 5 years; and
8    WHEREAS, Despite protections in the Patient Protection and
9Affordable Care Act (ACA), consumers are still exposed to the
10whims of health plans and pharmacy benefit managers (PBMs) when
11it comes to health services being changed or denied; and
12    WHEREAS, States may have statutory or regulatory
13protections for patients to continue health care if a health
14care provider is no longer with a health plan; very few states
15protect a patient when a health plan changes service or
16pharmaceutical coverage in the middle of the plan year; and
17    WHEREAS, The 2016 Letter to Issuers from the Centers for
18Medicare & Medicaid Services does require some health plans to
19increase transparency about what is covered; the federal
20government encourages but does not require health plans to
21temporarily cover non-formulary drugs as if they were on
22formulary and without imposing additional cost sharing when



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1either a person changes plans or the plan makes a change in the
2middle of a plan year; therefore, be it
4ASSEMBLY OF THE STATE OF ILLINOIS, that it is critical to
5promote, support, and encourage continuity of care for
6patients; and be it further
7    RESOLVED, That health benefits should be designed to
8support treatment decisions that are based on clinical judgment
9and patient or physician decision-making, not by costs to the
10payer, to promote long-term health; and be it further
11    RESOLVED, That the possibility of legislation should be
12examined to safeguard affordable and continuous patient access
13to health care services and treatments; and be it further
14    RESOLVED, That suitable copies of this resolution be
15delivered to the Governor, the Director of the Illinois
16Department of Insurance, the Director of the Illinois
17Department of Health and Family Services, and the Director of
18the Illinois Department of Public Health.