Rep. Laura Fine

Filed: 3/25/2014

 

 


 

 


 
09800HB3638ham003LRB098 12067 RPM 57302 a

1
AMENDMENT TO HOUSE BILL 3638

2    AMENDMENT NO. ______. Amend House Bill 3638 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5adding Section 364.3 as follows:
 
6    (215 ILCS 5/364.3 new)
7    Sec. 364.3. Prior authorization form; prescription
8benefits.
9    (a) Notwithstanding any other provision of law, on and
10after January 1, 2015, a health insurer that provides
11prescription drug benefits must, within 72 hours after receipt
12of a prior authorization form from a prescribing provider or
13pharmacist, either approve or deny the prior authorization. In
14the case of a denial, the health insurer shall provide the
15prescriber with the reason for the denial, an alternative
16covered medication, if applicable, and information regarding

 

 

09800HB3638ham003- 2 -LRB098 12067 RPM 57302 a

1the procedure for submitting an appeal to the denial.
2    In the case of an expedited coverage determination, the
3health insurer must either approve or deny the prior
4authorization within 24 hours after receipt of the prior
5authorization form. In the case of a denial, the health insurer
6shall provide the prescriber with the reason for the denial, an
7alternative covered medication, if applicable, and information
8regarding the procedure for submitting an appeal to the denial.
9    (b) Health insurers must provide confirmation of receipt of
10a prior authorization form within one hour after receipt of the
11prior authorization form.
12    (c) This Section does not apply to plans for beneficiaries
13of Medicare or Medicaid.
14    (d) For the purposes of this Section:
15    "Pharmacist" has the same meaning as set forth in the
16Pharmacy Practice Act.
17    "Prescribing provider" includes a provider authorized to
18write a prescription, as described in subsection (e) of Section
193 of the Pharmacy Practice Act, to treat a medical condition of
20an insured.
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law.".