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1
HOUSE RESOLUTION 450

 
2    WHEREAS, In response to high costs for specialty-tier
3prescription drugs for chronically ill, insured patients,
4employer health plans and employer prescription drug plans have
5increased enrollee cost sharing amounts, instituted
6coinsurance, and implemented specialty tiers; and
 
7    WHEREAS, The Medco 2011 Drug Trend Report showed that
8non-specialty medications grew at 1.1% in 2010 and specialty
9drugs grew at a pace of 17.4%; and
 
10    WHEREAS, The price of specialty-tier drugs is often higher
11than traditional generics or branded medications and can create
12significant financial pressures on employer health plans,
13employer prescription drug plans, and individuals who purchase
14an individual health insurance policy; and
 
15    WHEREAS, The National Conference of State Legislatures
16reports that between the years 2000 and 2009, copayments for
17insured workers have increased for specialty-tier drugs; and
 
18    WHEREAS, Medicare has used specialty tiers since 2006 to
19help control prescription drug costs on behalf of taxpayers;
20and
 

 

 

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1    WHEREAS, Nationally, 11% of employers utilize a
2coinsurance or percentage of the cost of fourth-tier or
3specialty-tier prescription medications to help control the
4cost of their prescription drug benefit plans; and
 
5    WHEREAS, Specialty-tier medications are often life-saving
6drugs and include medications for chronic diseases, including
7certain types of cancer, hemophilia, multiple sclerosis,
8myositis, neuropathy, arthritis, human immunodeficiency virus,
9and other diseases and disorders and do not have brand or
10generic alternatives; and
 
11    WHEREAS, Step therapy is a strategy offered by employer
12health plans and employer prescription drug plans to
13incentivize plan participants to utilize lower cost generics or
14preferred brand alternatives when available; and
 
15    WHEREAS, A specialty tier is a cost-sharing benefit
16structure utilized by employer health plans for prescription
17drugs that requires a consumer for any drug to pay a greater
18cost than that which applies for a non-preferred brand name
19drug; and
 
20    WHEREAS, Specialty tier benefit structures may place
21financial burdens upon insured individuals with chronic health
22care issues requiring prescription medication, and may lead to

 

 

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1decreased adherence or failure to take medications as
2prescribed, that may result in acute incidents and negative
3health outcomes such as doctor visits, emergency room visits,
4and hospital stays that can be much more expensive; therefore,
5be it
 
6    RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE
7NINETY-SEVENTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that
8the Department of Insurance shall (1) determine the impact a
9designed benefit plan that implements coinsurance for
10prescription medications has on individuals and employer
11health plans; (2) study the availability of manufacturer
12discounts and assistance plans to individuals and employers for
13specialty-tier medications; (3) determine the percentage of
14small group and large group health plans in this State
15providing prescription drug benefits and identify plan options
16used by employer health plans and individuals to assist them to
17contain the costs of their specialty drug benefits; and (4)
18identify and evaluate options for reducing any negative impacts
19of cost sharing, coinsurance, and specialty-tier pricing; and
20be it further
 
21    RESOLVED, That the Department of Insurance shall report to
22the General Assembly on the first day of November, 2012 on its
23findings, conclusions, and recommendations; and be it further
 

 

 

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1    RESOLVED, That a suitable copy of this resolution be
2delivered to the Director of Insurance.