HB4504 103RD GENERAL ASSEMBLY

LRB103 36828 RPS 66939 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4504

Introduced 1/31/2024, by Rep. Laura Faver Dias

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.71 new

Amends the Illinois Insurance Code. Provides that a health plan shall limit the total amount that a covered person is required to pay for a covered prescription inhaler at an amount not to exceed $25 per 30-day supply and shall limit the total amount that a covered person is required to pay for all covered prescription inhalers at an amount not to exceed $50 in total per 30 days. Provides that coverage for prescription inhalers shall not be subject to any deductible. Provides that nothing in the provisions prevents a health plan from reducing a covered person's cost sharing to an amount less than the cap. Authorizes rulemaking and enforcement by the Department of Insurance. Effective January 1, 2025.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by adding Section 356z.71 as follows:

(215 ILCS 5/356z.71 new)

Sec. 356z.71. Prescription inhalers.

(a) In this Section:

"Health plan" means a policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 103rd General Assembly that provides coverage for prescription inhalers.

"Prescription inhaler" means a prescribed medical device that delivers inhaled medications used to treat respiratory conditions and the prescribed inhaled medication. "Prescription inhaler" includes metered-dose inhalers, nebulizers, and dry powder inhalers. "Prescription inhaler" does not include inhalers available over the counter without a prescription to provide temporary relief from respiratory symptoms.

(b) A health plan shall limit the total amount that a covered person is required to pay for a covered prescription inhaler to an amount not to exceed $25 per 30-day supply and shall limit the total amount that a covered person is required to pay for all covered prescription inhalers to an amount not to exceed $50 in total per 30 days. Coverage for prescription inhalers shall not be subject to any deductible.

(c) Nothing in this Section prevents a health plan from reducing a covered person's cost sharing to an amount less than the amount specified in subsection (b).

(d) The Department may adopt rules necessary to implement and administer this Section and to align with federal requirements. The Department may use any of its enforcement powers to obtain a health plan's compliance with this Section.

Section 99. Effective date. This Act takes effect January 1, 2025.