summary
Introduced
02/07/2025
02/07/2025
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 plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 that provides coverage for prescription insulin drugs shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription weight loss drugs, such as Ozempic, Wegovy, and Moujaro, to an amount not to exceed $200, regardless of the quantity or type of covered prescription weight loss drug used to fill the insured's prescription. Provides that an insurer is not prohibited from reducing an insured's cost sharing by an amount greater than the specified amount. Grants the Department of Insurance rulemaking and enforcement authority. Provides that, on January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.
AI Summary
This bill amends various Illinois insurance laws to limit the out-of-pocket costs for prescription weight loss drugs like Ozempic, Wegovy, and Moujaro. Specifically, for group or individual health insurance plans renewed after January 1, 2026, insurers must cap the cost to insured individuals at $200 for a 30-day supply of covered prescription weight loss drugs, regardless of the specific drug or quantity. The bill defines these drugs as prescription medications administered intravenously to control weight. The cost-sharing limit will be adjusted annually based on the medical care component of the Consumer Price Index, allowing for gradual increases. The bill gives the Department of Insurance rulemaking and enforcement authority to implement these requirements. The legislation applies to various types of health insurance plans, including state employee plans, county and municipal plans, school district plans, health maintenance organizations, and the state medical assistance program. Insurers are not prohibited from reducing cost-sharing beyond the specified $200 limit, providing flexibility in how they manage these prescription drug costs.
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=3335&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB3335.htm |
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