summary
Introduced
02/27/2025
02/27/2025
In Committee
03/04/2025
03/04/2025
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 change how prescription drug cost sharing is calculated for health insurance policies starting January 1, 2026. Specifically, the bill requires that when a patient purchases a prescription drug, their out-of-pocket cost (cost sharing) must be calculated using a price that is reduced by 100% of the rebates the insurance company receives from drug manufacturers or pharmacies. Any rebate amount that exceeds the patient's cost sharing must be used by the insurer to lower overall health plan premiums. The bill also explicitly allows insurers to reduce a patient's cost sharing by more than the minimum required amount at the point of sale. Additionally, the Department of Insurance is authorized to create rules to implement these new requirements. This legislation aims to make prescription drugs more affordable for patients by ensuring that pharmaceutical rebates directly benefit consumers through lower upfront costs and potentially lower insurance premiums.
Sponsors (1)
Last Action
Referred to Rules Committee (on 03/04/2025)
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=4008&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB4008.htm |
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