Illinois General Assembly - Full Text of HR0450
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Full Text of HR0450  97th General Assembly



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2    AMENDMENT NO. ___. Amend House Resolution 450 by replacing
3everything after the title with the following:
4    "WHEREAS, In response to high costs for specialty-tier
5prescription drugs for chronically ill, insured patients,
6employer health plans and employer prescription drug plans have
7increased enrollee cost sharing amounts, instituted
8coinsurance, and implemented specialty tiers; and
9    WHEREAS, The Medco 2011 Drug Trend Report showed that
10non-specialty medications grew at 1.1% in 2010 and specialty
11drugs grew at a pace of 17.4%; and
12    WHEREAS, The price of specialty-tier drugs is often higher
13than traditional generics or branded medications and can create
14significant financial pressures on employer health plans,
15employer prescription drug plans, and individuals who purchase



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1an individual health insurance policy; and
2    WHEREAS, The National Conference of State Legislatures
3reports that between the years 2000 and 2009, copayments for
4insured workers have increased for specialty-tier drugs; and
5    WHEREAS, Medicare has used specialty tiers since 2006 to
6help control prescription drug costs on behalf of taxpayers;
8    WHEREAS, Nationally, 11% of employers utilize a
9coinsurance or percentage of the cost of fourth-tier or
10specialty-tier prescription medications to help control the
11cost of their prescription drug benefit plans; and
12    WHEREAS, Specialty-tier medications are often life-saving
13drugs and include medications for chronic diseases, including
14certain types of cancer, hemophilia, multiple sclerosis,
15myositis, neuropathy, arthritis, human immunodeficiency virus,
16and other diseases and disorders and do not have brand or
17generic alternatives; and
18    WHEREAS, Step therapy is a strategy offered by employer
19health plans and employer prescription drug plans to
20incentivize plan participants to utilize lower cost generics or
21preferred brand alternatives when available; and



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1    WHEREAS, A specialty tier is a cost-sharing benefit
2structure utilized by employer health plans for prescription
3drugs that requires a consumer for any drug to pay a greater
4cost than that which applies for a non-preferred brand name
5drug; and
6    WHEREAS, Specialty tier benefit structures may place
7financial burdens upon insured individuals with chronic health
8care issues requiring prescription medication, and may lead to
9decreased adherence or failure to take medications as
10prescribed, that may result in acute incidents and negative
11health outcomes such as doctor visits, emergency room visits,
12and hospital stays that can be much more expensive; therefore,
13be it
16the Department of Insurance shall (1) determine the impact a
17designed benefit plan that implements coinsurance for
18prescription medications has on individuals and employer
19health plans; (2) study the availability of manufacturer
20discounts and assistance plans to individuals and employers for
21specialty-tier medications; (3) determine the percentage of
22small group and large group health plans in this State
23providing prescription drug benefits and identify plan options



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1used by employer health plans and individuals to assist them to
2contain the costs of their specialty drug benefits; and (4)
3identify and evaluate options for reducing any negative impacts
4of cost sharing, coinsurance, and specialty-tier pricing; and
5be it further
6    RESOLVED, That the Department of Insurance shall report to
7the General Assembly on the first day of November, 2012 on its
8findings, conclusions, and recommendations; and be it further
9    RESOLVED, That a suitable copy of this resolution be
10delivered to the Director of Insurance.".