HB2174eng 101ST GENERAL ASSEMBLY

HB2174 Engrossed LRB101 07405 SMS 52445 b

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Managed Care Reform and Patient Rights Act is amended by adding Section 45.3 as follows:

(215 ILCS 134/45.3 new)

Sec. 45.3. Prescription drug benefits; plan choice.

(a) Notwithstanding any other provision of law, on or after January 1, 2020, every health insurance carrier that provides coverage for prescription drugs shall ensure that no fewer than 25% of individual and group plans offered within each service area and at each level of coverage as defined in 42 U.S.C. 18022, if applicable, that are delivered, issued for delivery, renewed, amended, or continued by the health insurance carrier shall apply a pre-deductible, flat-dollar copayment structure to the entire drug benefit, including all tiers. A health insurance carrier shall not apply the deductible or any coinsurance amount to the entire drug benefit for these plans. The flat-dollar copayment structure for prescription drugs under this subsection (a) must be reasonably graduated and proportionately related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs.

(b) A health insurance carrier shall clearly and appropriately name all plans described in subsection (a) to aid in the consumer or plan-sponsor plan selection process.

(c) A health insurance carrier shall market plans described in subsection (a) in the same manner as plans not described in subsection (a). With respect to group health plans, a health insurance carrier shall ensure that each group or plan sponsor has the option to purchase a plan described in subsection (a).

(d) If a health insurance carrier offers fewer than 4 plans in a service area, or in a service area and level of coverage, if applicable, the health insurance carrier shall ensure that one plan shall use the drug benefit structure, including cost-sharing requirements, set forth in subsection (a).

(e) The Department shall adopt rules necessary to implement and enforce the provisions of this Section.

Section 99. Effective date. This Act takes effect January 1, 2020.