103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB5518

 

Introduced 2/9/2024, by Rep. Jenn Ladisch Douglass

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/155.37a new

    Amends the Illinois Insurance Code. Provides that "State-regulated health plan" means any health insurance plan issued by an insurer regulated by the State or health insurance plan operated and administered by the State, including, but not limited to, the medical assistance program under the Medical Assistance Article of the Illinois Public Aid Code, fee-for-service plans, and managed care organizations. Provides that for every State-regulated health plan, an information packet on all insurance products offered to enrollees must be made available to the public, which must be viewable before choosing a health plan, that includes specified information concerning the plan's drug formulary and the costs for drugs. Provides that the information packet must be made available both online in any patient portal and in a printed format. Provides that the information packet must be updated within 7 days after any change to the drug formulary, and notice of the change to the drug formulary and change to drug costs must be sent to beneficiaries by mail or electronically.


LRB103 38809 RPS 68946 b

 

 

A BILL FOR

 

HB5518LRB103 38809 RPS 68946 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 Illinois Insurance Code is amended by
5adding Section 155.37a as follows:
 
6    (215 ILCS 5/155.37a new)
7    Sec. 155.37a. State-regulated health plan drug formulary
8posting.
9    (a) As used in this Section, "State-regulated health plan"
10means any health insurance plan issued by an insurer regulated
11by the State or health insurance plan operated and
12administered by the State, including, but not limited to, the
13medical assistance program under Article V of the Illinois
14Public Aid Code, fee-for-service plans, and managed care
15organizations.
16    (b) For every State-regulated health plan, an information
17packet on all insurance products offered to enrollees must be
18made available to the public, which must be viewable before
19choosing a health plan, that includes the following
20information:
21        (1) a current drug formulary listing all medications
22    and products available, including both generic and name
23    brand versions of each drug, and the tier for each drug;

 

 

HB5518- 2 -LRB103 38809 RPS 68946 b

1        (2) the out-of-pocket cost for each drug; and
2        (3) current information on copayments and any other
3    costs the patient might incur, including both the cost
4    before and after any deductibles and copayments are met.
5    (c) The information packet required under subsection (b)
6must be made available both online in any patient portal and in
7a printed format.
8    (d) The information packet required under subsection (b)
9must be updated within 7 days after any change to the drug
10formulary, and notice of the change to the drug formulary and
11change to drug costs must be sent to beneficiaries by mail or
12electronically.