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| Public Act 102-0391 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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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, beginning | ||||
January 1, 2023, every health insurance carrier that offers an | ||||
individual health plan that provides coverage for prescription | ||||
drugs shall ensure that at least 10% of individual health care | ||||
plans offered in each applicable service area and at each | ||||
level of coverage as defined in 42 U.S.C. 18022 apply a | ||||
flat-dollar copayment structure to the entire drug benefit. | ||||
Beginning January 1, 2024, every health insurance carrier that | ||||
offers an individual health plan that provides coverage for | ||||
prescription drugs shall ensure that at least 25% of | ||||
individual health care plans offered in each applicable | ||||
service area and at each level of coverage as defined in 42 | ||||
U.S.C. 18022 apply a flat-dollar copayment structure to the | ||||
entire drug benefit. If a health insurance carrier offers | ||||
fewer than 4 plans in a service area, then the health insurance | ||||
carrier shall ensure that one plan applies a flat-dollar | ||||
copayment structure to the entire drug benefit. | ||
(b) Beginning January 1, 2023, every health insurance | ||
carrier that offers a group health plan that provides coverage | ||
for prescription drugs shall offer at least one group health | ||
plan in each applicable service area and at each level of | ||
coverage as defined in 42 U.S.C. 18022 that applies a | ||
flat-dollar copayment structure to the entire drug benefit. | ||
Beginning January 1, 2024, every health insurance carrier that | ||
offers a group health plan that provides coverage for | ||
prescription drugs shall offer at least 2 group health plans | ||
in each applicable service area and at each level of coverage | ||
as defined in 42 U.S.C. 18022 that apply a flat-dollar | ||
copayment structure to the entire drug benefit. | ||
(c) The flat-dollar copayment structure for prescription | ||
drugs under subsections (a) and (b) must be applied | ||
pre-deductible and be reasonably graduated and proportionately | ||
related in all tier levels such that the copayment structure | ||
as a whole does not discriminate against or discourage the | ||
enrollment of individuals with significant health care needs. | ||
(d) A health insurance carrier that offers individual or | ||
group health care plans shall clearly and appropriately name | ||
the plans described in subsections (a) and (b) to aid in the | ||
individual or group plan selection process. | ||
(e) A health insurance carrier shall market plans | ||
described in subsections (a) and (b) in the same manner as | ||
plans not described in subsections (a) and (b). | ||
(f) The Department shall adopt rules necessary to | ||
implement and enforce the provisions of this Section.
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Section 99. Effective date. This Act takes effect January | ||
1, 2023.
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