summary
Introduced
01/09/2025
01/09/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2026 that provides coverage for prescription drugs shall require that a covered individual's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 100% of all rebates received in connection with the dispensation or administration of the prescription drug. Provides that an insurer shall apply any rebate amount in excess of the defined cost sharing amount to the health plan to reduce premiums. Provides that the provisions shall not preclude an insurer from decreasing a covered individual's defined cost sharing by an amount greater than the stated amount at the point of sale. Provides that the Department of Insurance may adopt rules to implement the provisions.
AI Summary
This bill amends the Illinois Insurance Code to address prescription drug cost sharing and rebates for group and individual health insurance policies. Starting January 1, 2026, the bill requires insurers to calculate a covered individual's out-of-pocket costs for prescription drugs at the point of sale by reducing the price by at least 100% of all drug rebates received. Any rebate amount that exceeds the defined cost sharing must be applied to reduce health plan premiums. The legislation allows insurers flexibility to further decrease an individual's cost sharing beyond the minimum requirement. Importantly, the bill empowers the Department of Insurance to create rules for implementing these provisions, ensuring proper execution of the new cost-sharing approach. The goal of this bill appears to be increasing transparency in drug pricing and providing more direct financial benefits to consumers by requiring insurers to pass drug rebates directly to patients through lower upfront costs or reduced premiums.
Committee Categories
Government Affairs
Sponsors (1)
Last Action
Rule 19(a) / Re-referred to Rules Committee (on 03/21/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ilga.gov/legislation/BillStatus.asp?DocNum=1171&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB1171.htm |
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