Public Act 102-0391
 
HB1745 EnrolledLRB102 14220 BMS 19572 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Managed Care Reform and Patient Rights Act
is amended by adding Section 45.3 as follows:
 
    (215 ILCS 134/45.3 new)
    Sec. 45.3. Prescription drug benefits; plan choice.
    (a) Notwithstanding any other provision of law, beginning
January 1, 2023, every health insurance carrier that offers an
individual health plan that provides coverage for prescription
drugs shall ensure that at least 10% of individual health care
plans offered in each applicable service area and at each
level of coverage as defined in 42 U.S.C. 18022 apply a
flat-dollar copayment structure to the entire drug benefit.
Beginning January 1, 2024, every health insurance carrier that
offers an individual health plan that provides coverage for
prescription drugs shall ensure that at least 25% of
individual health care plans offered in each applicable
service area and at each level of coverage as defined in 42
U.S.C. 18022 apply a flat-dollar copayment structure to the
entire drug benefit. If a health insurance carrier offers
fewer than 4 plans in a service area, then the health insurance
carrier shall ensure that one plan applies a flat-dollar
copayment structure to the entire drug benefit.
    (b) Beginning January 1, 2023, every health insurance
carrier that offers a group health plan that provides coverage
for prescription drugs shall offer at least one group health
plan in each applicable service area and at each level of
coverage as defined in 42 U.S.C. 18022 that applies a
flat-dollar copayment structure to the entire drug benefit.
Beginning January 1, 2024, every health insurance carrier that
offers a group health plan that provides coverage for
prescription drugs shall offer at least 2 group health plans
in each applicable service area and at each level of coverage
as defined in 42 U.S.C. 18022 that apply a flat-dollar
copayment structure to the entire drug benefit.
    (c) The flat-dollar copayment structure for prescription
drugs under subsections (a) and (b) must be applied
pre-deductible and be reasonably graduated and proportionately
related in all tier levels such that the copayment structure
as a whole does not discriminate against or discourage the
enrollment of individuals with significant health care needs.
    (d) A health insurance carrier that offers individual or
group health care plans shall clearly and appropriately name
the plans described in subsections (a) and (b) to aid in the
individual or group plan selection process.
    (e) A health insurance carrier shall market plans
described in subsections (a) and (b) in the same manner as
plans not described in subsections (a) and (b).
    (f) The Department shall adopt rules necessary to
implement and enforce the provisions of this Section.
 
    Section 99. Effective date. This Act takes effect January
1, 2023.