Full Text of SR1539 99th General Assembly
SR1539 99TH GENERAL ASSEMBLY |
| | SR1539 | | LRB099 17248 MST 44641 r |
|
| 1 | | SENATE RESOLUTION
| 2 | | WHEREAS, Patients, especially those with serious or | 3 | | chronic conditions, should be able to continue the course of
| 4 | | therapy recommended by their physician; and
| 5 | | WHEREAS, Health plans and pharmacy benefit managers (PBMs) | 6 | | have implemented policies called "non-medical
switching" that | 7 | | require patients to switch to cheaper, insurer-preferred | 8 | | drugs; these policies include making formulary
changes that | 9 | | limit or restrict access to certain treatments and increasing | 10 | | out-of-pocket costs; and
| 11 | | WHEREAS, A stable patient should not be required to switch | 12 | | treatments simply due to payer cost controls; and | 13 | | WHEREAS, Studies have shown that patients with chronic | 14 | | conditions, who have been stabilized on drug therapy and
then | 15 | | switched to another drug, face negative consequences, such as | 16 | | allergic reaction or lack of response; and | 17 | | WHEREAS, Nearly all health plans and PBMs in the United | 18 | | States switch patients between drugs as part of a utilization
| 19 | | management program offered to employers and other customers, | 20 | | including states; and |
| | | SR1539 | - 2 - | LRB099 17248 MST 44641 r |
|
| 1 | | WHEREAS, Switching a stable patient for non-medical | 2 | | reasons may be dangerous, is usually unnecessary, and rarely
| 3 | | generates overall cost savings; and | 4 | | WHEREAS, Out-of-pocket costs for patients can exceed 30% of | 5 | | the costs of primary care, specialist visits, and
some | 6 | | medications, while average deductibles have increased by 150% | 7 | | over the past 5 years; and
| 8 | | WHEREAS, Despite protections in the Patient Protection and | 9 | | Affordable Care Act (ACA), consumers are still exposed
to the | 10 | | whims of health plans and pharmacy benefit managers (PBMs) when | 11 | | it comes to health services being
changed or denied; and
| 12 | | WHEREAS, States may have statutory or regulatory | 13 | | protections for patients to continue health care if a health | 14 | | care
provider is no longer with a health plan; very few states | 15 | | protect a patient when a health plan changes service or
| 16 | | pharmaceutical coverage in the middle of the plan year; and
| 17 | | WHEREAS, The 2016 Letter to Issuers from the Centers for | 18 | | Medicare & Medicaid Services does require some health
plans to | 19 | | increase transparency about what is covered; the federal | 20 | | government encourages but does not require
health plans to | 21 | | temporarily cover non-formulary drugs as if they were on | 22 | | formulary and without imposing additional
cost sharing when |
| | | SR1539 | - 3 - | LRB099 17248 MST 44641 r |
|
| 1 | | either a person changes plans or the plan makes a change in the | 2 | | middle of a plan year; therefore, be it
| 3 | | RESOLVED, BY THE SENATE OF THE NINETY-NINTH GENERAL | 4 | | ASSEMBLY OF THE STATE OF ILLINOIS, that it is critical to | 5 | | promote, support, and encourage continuity of care for | 6 | | patients; and be it further | 7 | | RESOLVED, That health benefits should be designed to | 8 | | support treatment decisions that are based on clinical judgment | 9 | | and patient or physician decision-making, not by costs to the | 10 | | payer, to promote long-term health; and be it further | 11 | | RESOLVED, That the possibility of legislation should be | 12 | | examined to safeguard
affordable and continuous patient access | 13 | | to health care services and treatments; and be it further
| 14 | | RESOLVED, That suitable copies of this resolution be | 15 | | delivered to the Governor, the Director of the Illinois | 16 | | Department of Insurance, the Director of the Illinois | 17 | | Department of Health and Family Services, and the Director of | 18 | | the Illinois Department of Public Health.
|
|