summary
Introduced
02/03/2025
02/03/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Illinois Insurance Code. Requires any pharmacy benefit manager or health insurer to provide notice of a change in prescription drug coverage or pricing, including instructions on appeals and exceptions, to beneficiaries of health plans in the State who would be affected by the change. Provides that any pharmacy benefit manager or health insurer must, on or before July 30, 2026, submit to the Department for approval a plan by which beneficiaries may appeal, or request an exception to, a contemplated change in coverage. Provides that this process must allow beneficiaries to present evidence for their appeal or exception. Provides that if the Department of Insurance determines that the processes for requesting appeals or exceptions are insufficient, or do not adequately rely on medical necessity, the Department shall set forth required changes to the process within 90 days of receipt. Provides that if the pharmacy benefit manager or health insurer disputes the changes, a hearing may be requested within 10 days after receipt of the changes, and the Department shall enter a final written decision within 5 days of the hearing.
AI Summary
This bill amends the Illinois Insurance Code to enhance transparency and consumer protections in prescription drug coverage. Specifically, it requires pharmacy benefit managers and health insurers to provide written notice at least 90 days in advance of any changes in prescription drug coverage or pricing that would impact health plan beneficiaries. The notice must be sent by first-class mail or email and include detailed information such as cost-sharing details, proposed coverage changes, and instructions for appealing or requesting exceptions to the changes. The bill defines key terms like "cost-sharing information" (the amount a covered individual pays for a drug) and "coverage" (health care services available under a health plan). By mandating advance notice and clear communication, the bill aims to give health plan beneficiaries more information and opportunities to understand and potentially contest prescription drug coverage modifications that could affect their healthcare expenses and access to medications.
Committee Categories
Business and Industry
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=2440&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB2440.htm |
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