HR0450enr 97TH GENERAL ASSEMBLY

HR0450 Enrolled LRB097 12219 RPM 56653 r

HOUSE RESOLUTION 450

WHEREAS, In response to high costs for specialty-tier prescription drugs for chronically ill, insured patients, employer health plans and employer prescription drug plans have increased enrollee cost sharing amounts, instituted coinsurance, and implemented specialty tiers; and

WHEREAS, The Medco 2011 Drug Trend Report showed that non-specialty medications grew at 1.1% in 2010 and specialty drugs grew at a pace of 17.4%; and

WHEREAS, The price of specialty-tier drugs is often higher than traditional generics or branded medications and can create significant financial pressures on employer health plans, employer prescription drug plans, and individuals who purchase an individual health insurance policy; and

WHEREAS, The National Conference of State Legislatures reports that between the years 2000 and 2009, copayments for insured workers have increased for specialty-tier drugs; and

WHEREAS, Medicare has used specialty tiers since 2006 to help control prescription drug costs on behalf of taxpayers; and

WHEREAS, Nationally, 11% of employers utilize a coinsurance or percentage of the cost of fourth-tier or specialty-tier prescription medications to help control the cost of their prescription drug benefit plans; and

WHEREAS, Specialty-tier medications are often life-saving drugs and include medications for chronic diseases, including certain types of cancer, hemophilia, multiple sclerosis, myositis, neuropathy, arthritis, human immunodeficiency virus, and other diseases and disorders and do not have brand or generic alternatives; and

WHEREAS, Step therapy is a strategy offered by employer health plans and employer prescription drug plans to incentivize plan participants to utilize lower cost generics or preferred brand alternatives when available; and

WHEREAS, A specialty tier is a cost-sharing benefit structure utilized by employer health plans for prescription drugs that requires a consumer for any drug to pay a greater cost than that which applies for a non-preferred brand name drug; and

WHEREAS, Specialty tier benefit structures may place financial burdens upon insured individuals with chronic health care issues requiring prescription medication, and may lead to decreased adherence or failure to take medications as prescribed, that may result in acute incidents and negative health outcomes such as doctor visits, emergency room visits, and hospital stays that can be much more expensive; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE NINETY-SEVENTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that the Department of Insurance shall (1) determine the impact a designed benefit plan that implements coinsurance for prescription medications has on individuals and employer health plans; (2) study the availability of manufacturer discounts and assistance plans to individuals and employers for specialty-tier medications; (3) determine the percentage of small group and large group health plans in this State providing prescription drug benefits and identify plan options used by employer health plans and individuals to assist them to contain the costs of their specialty drug benefits; and (4) identify and evaluate options for reducing any negative impacts of cost sharing, coinsurance, and specialty-tier pricing; and be it further

RESOLVED, That the Department of Insurance shall report to the General Assembly on the first day of November, 2012 on its findings, conclusions, and recommendations; and be it further

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