HB2174 EngrossedLRB101 07405 SMS 52445 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Managed Care Reform and Patient Rights Act
5is amended by adding Section 45.3 as follows:
6    (215 ILCS 134/45.3 new)
7    Sec. 45.3. Prescription drug benefits; plan choice.
8    (a) Notwithstanding any other provision of law, on or after
9January 1, 2020, every health insurance carrier that provides
10coverage for prescription drugs shall ensure that no fewer than
1125% of individual and group plans offered within each service
12area and at each level of coverage as defined in 42 U.S.C.
1318022, if applicable, that are delivered, issued for delivery,
14renewed, amended, or continued by the health insurance carrier
15shall apply a pre-deductible, flat-dollar copayment structure
16to the entire drug benefit, including all tiers. A health
17insurance carrier shall not apply the deductible or any
18coinsurance amount to the entire drug benefit for these plans.
19The flat-dollar copayment structure for prescription drugs
20under this subsection (a) must be reasonably graduated and
21proportionately related in all tier levels such that the
22copayment structure as a whole does not discriminate against or
23discourage the enrollment of individuals with significant



HB2174 Engrossed- 2 -LRB101 07405 SMS 52445 b

1health care needs.
2    (b) A health insurance carrier shall clearly and
3appropriately name all plans described in subsection (a) to aid
4in the consumer or plan-sponsor plan selection process.
5    (c) A health insurance carrier shall market plans described
6in subsection (a) in the same manner as plans not described in
7subsection (a). With respect to group health plans, a health
8insurance carrier shall ensure that each group or plan sponsor
9has the option to purchase a plan described in subsection (a).
10    (d) If a health insurance carrier offers fewer than 4 plans
11in a service area, or in a service area and level of coverage,
12if applicable, the health insurance carrier shall ensure that
13one plan shall use the drug benefit structure, including
14cost-sharing requirements, set forth in subsection (a).
15    (e) The Department shall adopt rules necessary to implement
16and enforce the provisions of this Section.
17    Section 99. Effective date. This Act takes effect January
181, 2020.