SB1559 EngrossedLRB103 29878 BMS 56288 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 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 discount program.
3    (a) The Department shall offer a discount program that
4allows participants to purchase insulin at a discounted,
5post-rebate price.
6    (b) The discount program shall:
7        (1) provide a participant with a card or electronic
8    document that identifies the participant as eligible for
9    the discount;
10        (2) provide a participant with information about
11    pharmacies that will honor the discount;
12        (3) allow a participant to purchase insulin at a
13    discounted, post-rebate price; and
14        (4) provide a participant with instructions to pursue
15    a reimbursement of the purchase price from the
16    participant's health insurer.
17    (c) The discount program shall charge a price for insulin
18that allows the program to retain only enough of any rebate for
19the insulin to make the State risk pool whole for providing
20discounted insulin to participants.
21    Section 90. The Illinois Insurance Code is amended by
22changing Section 356z.41 as follows:
23    (215 ILCS 5/356z.41)



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1    Sec. 356z.41. Cost sharing in prescription insulin drugs;
2limits; confidentiality of rebate information.
3    (a) As used in this Section, "prescription insulin drug"
4means a prescription drug that contains insulin and is used to
5control blood glucose levels to treat diabetes but does not
6include an insulin drug that is administered to a patient
8    (b) This Section applies to a group or individual policy
9of accident and health insurance amended, delivered, issued,
10or renewed on or after the effective date of this amendatory
11Act of the 101st General Assembly.
12    (c) An insurer that provides coverage for prescription
13insulin drugs pursuant to the terms of a health coverage plan
14the insurer offers shall limit the total amount that an
15insured is required to pay for a 30-day supply of covered
16prescription insulin drugs at an amount not to exceed $35
17$100, regardless of the quantity or type of covered
18prescription insulin drug used to fill the insured's
20    (d) Nothing in this Section prevents an insurer from
21reducing an insured's cost sharing by an amount greater than
22the amount specified in subsection (c).
23    (e) The Director may use any of the Director's enforcement
24powers to obtain an insurer's compliance with this Section.
25    (f) The Department may adopt rules as necessary to
26implement and administer this Section and to align it with



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1federal requirements.
2    (g) On January 1 of each year, the limit on the amount that
3an insured is required to pay for a 30-day supply of a covered
4prescription insulin drug shall increase by a percentage equal
5to the percentage change from the preceding year in the
6medical care component of the Consumer Price Index of the
7Bureau of Labor Statistics of the United States Department of
9(Source: P.A. 101-625, eff. 1-1-21.)
10    Section 99. Effective date. This Act takes effect January
111, 2025.