Bill Text: IL HB4477 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Managed Care Reform and Patient Rights Act. Requires health insurance carriers that provide coverage for prescription drugs to ensure that, within service areas and levels of coverage specified by federal law, at least half of individual and group plans meet one or more of the following criteria: apply a pre-deductible and flat-dollar copayment structure to the entire drug benefit, limit a beneficiary's monthly out-of-pocket financial responsibility for prescription drugs to a specified amount, or limit a beneficiary's annual out-of-pocket financial responsibility for prescription drugs to a specified amount. Provides that all plans for prescription drugs offered under the amendatory Act must be clearly and appropriately named, marketed in the same manner as other plans offered by the health insurance carrier, and offered for purchase to any individual and group plan sponsor. Effective January 1, 2021.

Spectrum: Partisan Bill (Democrat 27-0)

Status: (Introduced - Dead) 2020-06-25 - Added Co-Sponsor Rep. Mary Edly-Allen [HB4477 Detail]

Download: Illinois-2019-HB4477-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB4477 Introduced , by Rep. Gregory Harris SYNOPSIS AS INTRODUCED:
215 ILCS 134/45.3 new
Amends the Managed Care Reform and Patient Rights Act. Requires health insurance carriers that provide coverage for prescription drugs to ensure that, within service areas and levels of coverage specified by federal law, at least half of individual and group plans meet one or more of the following criteria: apply a pre-deductible and flat-dollar copayment structure to the entire drug benefit, limit a beneficiary's monthly out-of-pocket financial responsibility for prescription drugs to a specified amount, or limit a beneficiary's annual out-of-pocket financial responsibility for prescription drugs to a specified amount. Provides that all plans for prescription drugs offered under the amendatory Act must be clearly and appropriately named, marketed in the same manner as other plans offered by the health insurance carrier, and offered for purchase to any individual and group plan sponsor. Effective January 1, 2021.
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Managed Care Reform and Patient Rights Act
is amended by adding Section 45.3 as follows:
(215 ILCS 134/45.3 new)
Sec. 45.3. Prescription drug benefits; plan choice.
(a) Notwithstanding any other provision of law, on and
after January 1, 2021, every health insurance carrier that
provides coverage for prescription drugs shall ensure that no
fewer than 50% of individual and group plans offered within
each service area and at each level of coverage as defined in
42 U.S.C. 18022, if applicable, that are delivered, issued for
delivery, renewed, amended, or continued by the health
insurance carrier meet one or more of the following criteria:
(1) apply a pre-deductible and flat-dollar copayment
structure to the entire drug benefit, including all tiers;
the flat-dollar copayment tier structure for prescription
drugs under this Section must be graduated and
proportionate;
(2) limit a beneficiary's monthly out-of-pocket
financial responsibility, including any copayment or
coinsurance, for prescription drugs, including specialty

HB4477 - 2 - LRB101 18735 BMS 68190 b
drugs, to no more than $150 per month for each prescription
drug for up to a 30-day supply of any single drug; the
out-of-pocket limit established under this Section shall
apply pre-deductible, if applicable; or
(3) limit a beneficiary's annual out-of-pocket
financial responsibility for prescription drugs, including
specialty drugs, to no more than the minimum per year
dollar amounts in effect under Section 223(c)(2)(A)(i) of
the Internal Revenue Code for self-only coverage.
(b) All plans offered pursuant to this Section shall be:
(1) clearly and appropriately named to aid in the
consumer or plan-sponsor plan selection process;
(2) marketed in the same manner as other plans offered
by the health insurance carrier; and
(3) offered for purchase to any individual and group
plan sponsor.
(c) The Department shall adopt rules necessary to implement
and enforce this Section.
Section 99. Effective date. This Act takes effect January
1, 2021.