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Synopsis As Introduced Amends the Illinois Insurance Code, the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code. Provides that government programs and accident and health insurance policies providing coverage for prescription drugs shall provide coverage for abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list, or other lists of similar construct. Prohibits cost sharing for abuse-deterrent opioid analgesic drugs that exceeds the lowest cost sharing level applied to prescription drugs. Prohibits insurers from requiring require that a covered individual first use an opioid analgesic drug product without abuse-deterrence labeling claims before providing coverage for an abuse-deterrent opioid analgesic product. Provides that any prior authorization requirements or other utilization review measures for opioid analgesic drug products, and any service denials made under those, shall not require first use of non-abuse-deterrent opioid analgesic drug products in order to access opioid analgesic drug products with abuse-deterrent properties.
Judicial Note (Admin Office of the Illinois Courts)
This bill would neither increase nor decrease the number of judges needed in the State.
Balanced Budget Note (Office of Management and Budget)
Passage of this bill without an accompanying source of revenue will result in an unbalanced budget.
State Debt Impact Note (Government Forecasting & Accountability)
HB 2743 would not change the amount of authorization for any type of State-issued or State-supported bond, and, therefore, would not affect the level of State indebtedness.
HB 2743 will not impact any public pension fund or retirement system in Illinois.
Housing Affordability Impact Note (Housing Development Authority)
This bill will have no effect on the cost of constructing, purchasing, owning, or selling a single-family residence.
Land Conveyance Appraisal Note (Dept. of Transportation)
No land conveyances are included in this bill; therefore, there are no appraisals to be filed.
Fiscal Note (Dept. of Healthcare & Family Services)
The cost for the Department of Healthcare and Family Services would be $55 million at a 35% utilization shift.
Correctional Note (Dept of Corrections)
There are no penalty enhancements associated with this bill. The bill would have no fiscal or population impact on the Department of Corrections.
Home Rule Note (Dept. of Commerce & Economic Opportunity)
This bill does not pre-empt hole rule authority.
State Mandates Fiscal Note (Dept. of Commerce & Economic Opportunity)
This bill does not create a State mandate.
Judicial Note, House Floor Amendment No. 3 (Admin Office of the Illinois Courts)
This bill would neither increase nor decrease the number of judges needed in the State.
Fiscal Note, House Floor Amendment No. 3 (Dept. of Central Management Services)
The Department of Central Management Services has contacted the vendor, CVS Caremark to conduct the financial analysis. CMS does not retain that level of detail. The following is the summary of impact from CVS: (1) The annualized cost impact if 10% of non-abuse deterrent prescriptions move to the abuse-deterrent formulation is estimated at $6.005.041; (2) The annualized cost impact if 35% of non-abuse deterrent prescriptions move to the abuse-deterrent formulation is estimated at $21.017.646; (3) The annualized cost impact if 50% of non-abuse deterrent prescriptions move to the abuse-deterrent formulation is estimated at $30.025.209.
Fiscal Note, House Floor Amendment No. 3 (Dept. of Healthcare & Family Services)
Providing coverage for these abuse-deterrent drugs to the managed care population will have a fiscal impact between $69 million (with 25% of users shifting to abuse-deterrent formulations) and $217 million (with a 100% shift to abuse-deterrent formulations). This cost would be added to the MCO capitation payments; however not eligible for federal matching funds.
State Mandates Fiscal Note, House Floor Amendment No. 3 (Dept. of Commerce & Economic Opportunity)
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