summary
Introduced
02/07/2025
02/07/2025
In Committee
04/11/2025
04/11/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Prior Authorization Reform Act. Provides that the Act applies to policies issued or delivered to persons who are enrolled in the State Employee Group Health Insurance Program to the extent required under a provision of the State Employees Group Insurance Act of 1971 concerning required health benefits. Provides that a health insurance issuer shall not require prior authorization where a covered medication, with the exception of benzodiazepines or Schedule II narcotic drugs: (1) is prescribed for the management and treatment of multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes type 1, diabetes type 2, or pre-diabetes; and (2) is for a patient currently managed with an established treatment regimen for at least 12 months. Provides that nothing in the provision prevents a health care plan from denying an enrollee coverage or imposing a prior authorization requirement if the United States Food and Drug Administration has issued a statement about the drug that calls into question the clinical safety of the drug, the drug manufacturer has notified the United States Food and Drug Administration of a manufacturing discontinuance or potential discontinuance of the drug, or the drug manufacturer has removed the drug from the market. In a provision concerning the length of prior authorization approval for treatment of chronic or long-term condition, excludes a provision of the State Employees Group Insurance Act of 1971 concerning coverage for injectable medicines to improve glucose or weight loss. Effective January 1, 2027.
AI Summary
This bill amends the Prior Authorization Reform Act and the State Employees Group Insurance Act to modify prior authorization requirements for certain health insurance policies. The bill eliminates prior authorization requirements for specific medications used to treat chronic conditions like multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, and diabetes, but only for patients who have been on a stable treatment regimen for at least 12 months. Importantly, the bill still allows health insurance plans to impose prior authorization or deny coverage if the FDA has raised safety concerns about a drug, if a drug manufacturer has signaled potential discontinuation of a medication, or if a drug has been removed from the market. The legislation specifically excludes benzodiazepines and Schedule II narcotic drugs from these relaxed authorization requirements. The bill also clarifies that insurance policies are not required to cover treatments that are already completely excluded from their benefits. The changes will take effect on January 1, 2027, and are primarily aimed at reducing administrative barriers for patients managing chronic health conditions by streamlining the prior authorization process for stable, long-term medication regimens.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Rule 3-9(a) / Re-referred to Assignments (on 04/11/2025)
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=2152&GAID=18&DocTypeID=SB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/SB/10400SB2152.htm |
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