State of Illinois
2023 and 2024


Introduced 2/8/2023, by Sen. Laura M. Murphy


New Act
215 ILCS 5/356z.41

    Creates the Access to Affordable Insulin Act. Sets forth provisions concerning an insulin urgent-need program. Provides that the Department of Public Health shall establish procedures and applications for the insulin urgent-need program. Sets forth provisions concerning insulin urgent-need program exceptions, eligibility, forms, applications, claims and reimbursement, copayments, information sheets, and navigators. Defines terms. Amends the Illinois Insurance Code. In provisions concerning cost sharing in prescription insulin drugs, provides that an insurer that provides coverage for prescription insulin drugs under the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $35 (rather than $100). Effective immediately.

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1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the Access
5to Affordable Insulin Act.
6    Section 5. Definitions. As used in this Act:
7    "Department" means the Department of Public Health.
8    "Insulin" means a prescription drug that contains insulin.
9    "Manufacturer" means a manufacturer engaged in the
10manufacturing of insulin that is self-administered on an
11outpatient basis.
12    "Navigator" has the meaning described in Section 1311(i)
13of the Patient Protection and Affordable Care Act, Public Law
14111-148, and further defined through amendments to that Act
15and regulations issued under that Act.
16    "Pharmacy" means a pharmacy located in this State.
17    "Prescription drug" means a drug that is required by
18federal or State law or rule to be dispensed only by
19prescription or that is restricted to administration only by
21    "Urgent need of insulin" means having readily available
22for use less than a 7-day supply of insulin and in need of
23insulin in order to avoid the likelihood of suffering



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1significant health consequences.
2    Section 10. Insulin urgent-need program.
3    (a) To be eligible to receive an urgent-need supply of
4insulin under this Section, an individual must attest to:
5        (1) being a resident of this State;
6        (2) not being enrolled in a medical assistance program
7    under the Illinois Public Aid Code;
8        (3) not being enrolled in prescription drug coverage
9    that limits the total amount of cost sharing that the
10    enrollee is required to pay for a 30-day supply of
11    insulin, including copayments, deductibles, or
12    coinsurance, to $35 or less, regardless of the type or
13    amount of insulin prescribed;
14        (4) not having received an urgent-need supply of
15    insulin through this program within the previous 12
16    months, unless authorized under subsection (m) or (n); and
17        (5) being in urgent need of insulin.
18    (b) The Department shall develop an application form to be
19used by an individual who is in urgent need of insulin. The
20application must ask the individual to attest to the
21eligibility requirements described in subsection (a). The form
22shall be accessible through the Department's website. The
23Department shall also make the form available to pharmacies
24and health care providers who prescribe or dispense insulin,
25hospital emergency departments, urgent care clinics, and



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1community health clinics. By submitting a completed, signed,
2and dated application to a pharmacy, the individual attests
3that the information contained in the application is correct.
4    (c) If an individual is in urgent need of insulin, the
5individual may present a completed, signed, and dated
6application form to a pharmacy. The individual must also:
7        (1) have a valid insulin prescription; and
8        (2) present the pharmacist with identification
9    indicating Illinois residency in the form of a valid
10    Illinois identification card, driver's license, or permit;
11    if the individual in urgent need of insulin is under the
12    age of 18, the individual's parent or legal guardian must
13    provide the pharmacist with proof of residency.
14    (d) Upon receipt of a completed and signed application, a
15pharmacist shall dispense the prescribed insulin in an amount
16that will provide the individual with a 30-day supply. The
17pharmacy shall notify the health care practitioner who issued
18the prescription order no later than 72 hours after the
19insulin is dispensed.
20    (e) A pharmacy may submit to the manufacturer of the
21dispensed insulin product or to the manufacturer's vendor a
22claim for payment that is in accordance with the National
23Council for Prescription Drug Program standards for electronic
24claims processing, unless the manufacturer agrees to send to
25the pharmacy a replacement supply of the same insulin as
26dispensed in the amount dispensed. If the pharmacy submits an



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1electronic claim to the manufacturer or the manufacturer's
2vendor, the manufacturer or vendor shall reimburse the
3pharmacy in an amount that covers the pharmacy's acquisition
5    (f) A pharmacy may collect an insulin copayment from an
6individual to cover the pharmacy's costs of processing and
7dispensing in an amount not to exceed $35 for the 30-day supply
8of insulin dispensed.
9    (g) The pharmacy shall also provide each eligible
10individual with the information sheet described in subsection
11(i) and a list of trained navigators provided by the
12Department for the individual to contact if the individual is
13in need of accessing ongoing insulin coverage options,
14including assistance in:
15        (1) applying for medical assistance;
16        (2) applying for a qualified health plan, subject to
17    open and special enrollment periods;
18        (3) accessing information on providers who participate
19    in prescription drug discount programs, including
20    providers who are authorized to participate in the 340B
21    program under Section 340b of the Public Health Services
22    Act, Section 256b of Title 42 of the United States Code;
23    and
24        (4) accessing insulin manufacturers' copayment
25    assistance programs and other foundation-based programs.
26    (h) A pharmacist shall retain a copy of the application



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1form submitted by the individual to the pharmacy for reporting
2and auditing purposes.
3    (i) The Department shall develop an information sheet to
4post on its website and provide a link to the information sheet
5on the board's website for pharmacies, health care
6practitioners, hospital emergency departments, urgent care
7clinics, and community health clinics. The information sheet
8shall contain:
9        (1) a description of the urgent-need insulin program,
10    including how to access the program;
11        (2) a description of each insulin manufacturer's
12    cost-sharing assistance program, including contact
13    information on accessing the assistance program for each
14    manufacturer;
15        (3) information on how to contact a trained navigator
16    for assistance in applying for medical assistance or a
17    qualified health plan; and
18        (4) notification that an individual in need of
19    assistance may contact the individual's local county
20    social service department for more information or
21    assistance in accessing ongoing affordable insulin
22    options.
23    (j) The Department shall also inform each individual who
24accesses urgent-need insulin under this Section that the
25individual may participate in a survey conducted by the
26Department regarding satisfaction with the program. The



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1Department shall provide contact information for the
2individual to learn more about the survey and how to
3participate. This information may be included on the
4information sheet described in subsection (i).
5    (k) The Department shall develop a training program for
6navigators to provide navigators with information and
7resources necessary to assist individuals in accessing
8appropriate long-term insulin options.
9    (l) The Department shall compile a list of navigators who
10have completed the training program and who are available to
11assist individuals in accessing affordable insulin coverage
12options. The list shall be made available through the
13Department's website and to pharmacies and health care
14practitioners who dispense and prescribe insulin.
15    (m) If an individual has applied for the medical
16assistance program under the Illinois Public Aid Code but has
17not been determined eligible or has been determined eligible
18but coverage has not become effective, the individual may
19access urgent-need insulin if the individual is in urgent need
20of insulin as defined in Section 5.
21    (n) To access an additional 30-day supply of insulin, an
22individual must attest to the pharmacy that the individual
23meets the requirements of subsection (m) and must comply with
24subsection (c).
25    Section 90. The Illinois Insurance Code is amended by



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1changing Section 356z.41 as follows:
2    (215 ILCS 5/356z.41)
3    Sec. 356z.41. Cost sharing in prescription insulin drugs;
4limits; confidentiality of rebate information.
5    (a) As used in this Section, "prescription insulin drug"
6means a prescription drug that contains insulin and is used to
7control blood glucose levels to treat diabetes but does not
8include an insulin drug that is administered to a patient
10    (b) This Section applies to a group or individual policy
11of accident and health insurance amended, delivered, issued,
12or renewed on or after the effective date of this amendatory
13Act of the 101st General Assembly.
14    (c) An insurer that provides coverage for prescription
15insulin drugs pursuant to the terms of a health coverage plan
16the insurer offers shall limit the total amount that an
17insured is required to pay for a 30-day supply of covered
18prescription insulin drugs at an amount not to exceed $35
19$100, regardless of the quantity or type of covered
20prescription insulin drug used to fill the insured's
22    (d) Nothing in this Section prevents an insurer from
23reducing an insured's cost sharing by an amount greater than
24the amount specified in subsection (c).
25    (e) The Director may use any of the Director's enforcement



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1powers to obtain an insurer's compliance with this Section.
2    (f) The Department may adopt rules as necessary to
3implement and administer this Section and to align it with
4federal requirements.
5    (g) On January 1 of each year, the limit on the amount that
6an insured is required to pay for a 30-day supply of a covered
7prescription insulin drug shall increase by a percentage equal
8to the percentage change from the preceding year in the
9medical care component of the Consumer Price Index of the
10Bureau of Labor Statistics of the United States Department of
12(Source: P.A. 101-625, eff. 1-1-21.)
13    Section 99. Effective date. This Act takes effect upon
14becoming law.