SB1559 103RD GENERAL ASSEMBLY

LRB103 29878 BMS 56288 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1559

Introduced 2/8/2023, by Sen. Laura M. Murphy

SYNOPSIS AS INTRODUCED:

New Act
215 ILCS 5/356z.41

Creates the Access to Affordable Insulin Act. Sets forth provisions concerning an insulin urgent-need program. Provides that the Department of Public Health shall establish procedures and applications for the insulin urgent-need program. Sets forth provisions concerning insulin urgent-need program exceptions, eligibility, forms, applications, claims and reimbursement, copayments, information sheets, and navigators. Defines terms. Amends the Illinois Insurance Code. In provisions concerning cost sharing in prescription insulin drugs, provides that an insurer that provides coverage for prescription insulin drugs under the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $35 (rather than $100). Effective immediately.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Access to Affordable Insulin Act.

Section 5. Definitions. As used in this Act:

"Department" means the Department of Public Health.

"Insulin" means a prescription drug that contains insulin.

"Manufacturer" means a manufacturer engaged in the manufacturing of insulin that is self-administered on an outpatient basis.

"Navigator" has the meaning described in Section 1311(i) of the Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to that Act and regulations issued under that Act.

"Pharmacy" means a pharmacy located in this State.

"Prescription drug" means a drug that is required by federal or State law or rule to be dispensed only by prescription or that is restricted to administration only by practitioners.

"Urgent need of insulin" means having readily available for use less than a 7-day supply of insulin and in need of insulin in order to avoid the likelihood of suffering significant health consequences.

Section 10. Insulin urgent-need program.

(a) To be eligible to receive an urgent-need supply of insulin under this Section, an individual must attest to:

(1) being a resident of this State;

(2) not being enrolled in a medical assistance program under the Illinois Public Aid Code;

(3) not being enrolled in prescription drug coverage that limits the total amount of cost sharing that the enrollee is required to pay for a 30-day supply of insulin, including copayments, deductibles, or coinsurance, to $35 or less, regardless of the type or amount of insulin prescribed;

(4) not having received an urgent-need supply of insulin through this program within the previous 12 months, unless authorized under subsection (m) or (n); and

(5) being in urgent need of insulin.

(b) The Department shall develop an application form to be used by an individual who is in urgent need of insulin. The application must ask the individual to attest to the eligibility requirements described in subsection (a). The form shall be accessible through the Department's website. The Department shall also make the form available to pharmacies and health care providers who prescribe or dispense insulin, hospital emergency departments, urgent care clinics, and community health clinics. By submitting a completed, signed, and dated application to a pharmacy, the individual attests that the information contained in the application is correct.

(c) If an individual is in urgent need of insulin, the individual may present a completed, signed, and dated application form to a pharmacy. The individual must also:

(1) have a valid insulin prescription; and

(2) present the pharmacist with identification indicating Illinois residency in the form of a valid Illinois identification card, driver's license, or permit; if the individual in urgent need of insulin is under the age of 18, the individual's parent or legal guardian must provide the pharmacist with proof of residency.

(d) Upon receipt of a completed and signed application, a pharmacist shall dispense the prescribed insulin in an amount that will provide the individual with a 30-day supply. The pharmacy shall notify the health care practitioner who issued the prescription order no later than 72 hours after the insulin is dispensed.

(e) A pharmacy may submit to the manufacturer of the dispensed insulin product or to the manufacturer's vendor a claim for payment that is in accordance with the National Council for Prescription Drug Program standards for electronic claims processing, unless the manufacturer agrees to send to the pharmacy a replacement supply of the same insulin as dispensed in the amount dispensed. If the pharmacy submits an electronic claim to the manufacturer or the manufacturer's vendor, the manufacturer or vendor shall reimburse the pharmacy in an amount that covers the pharmacy's acquisition cost.

(f) A pharmacy may collect an insulin copayment from an individual to cover the pharmacy's costs of processing and dispensing in an amount not to exceed $35 for the 30-day supply of insulin dispensed.

(g) The pharmacy shall also provide each eligible individual with the information sheet described in subsection (i) and a list of trained navigators provided by the Department for the individual to contact if the individual is in need of accessing ongoing insulin coverage options, including assistance in:

(1) applying for medical assistance;

(2) applying for a qualified health plan, subject to open and special enrollment periods;

(3) accessing information on providers who participate in prescription drug discount programs, including providers who are authorized to participate in the 340B program under Section 340b of the Public Health Services Act, Section 256b of Title 42 of the United States Code; and

(4) accessing insulin manufacturers' copayment assistance programs and other foundation-based programs.

(h) A pharmacist shall retain a copy of the application form submitted by the individual to the pharmacy for reporting and auditing purposes.

(i) The Department shall develop an information sheet to post on its website and provide a link to the information sheet on the board's website for pharmacies, health care practitioners, hospital emergency departments, urgent care clinics, and community health clinics. The information sheet shall contain:

(1) a description of the urgent-need insulin program, including how to access the program;

(2) a description of each insulin manufacturer's cost-sharing assistance program, including contact information on accessing the assistance program for each manufacturer;

(3) information on how to contact a trained navigator for assistance in applying for medical assistance or a qualified health plan; and

(4) notification that an individual in need of assistance may contact the individual's local county social service department for more information or assistance in accessing ongoing affordable insulin options.

(j) The Department shall also inform each individual who accesses urgent-need insulin under this Section that the individual may participate in a survey conducted by the Department regarding satisfaction with the program. The Department shall provide contact information for the individual to learn more about the survey and how to participate. This information may be included on the information sheet described in subsection (i).

(k) The Department shall develop a training program for navigators to provide navigators with information and resources necessary to assist individuals in accessing appropriate long-term insulin options.

(l) The Department shall compile a list of navigators who have completed the training program and who are available to assist individuals in accessing affordable insulin coverage options. The list shall be made available through the Department's website and to pharmacies and health care practitioners who dispense and prescribe insulin.

(m) If an individual has applied for the medical assistance program under the Illinois Public Aid Code but has not been determined eligible or has been determined eligible but coverage has not become effective, the individual may access urgent-need insulin if the individual is in urgent need of insulin as defined in Section 5.

(n) To access an additional 30-day supply of insulin, an individual must attest to the pharmacy that the individual meets the requirements of subsection (m) and must comply with subsection (c).

Section 90. The Illinois Insurance Code is amended by changing Section 356z.41 as follows:

(215 ILCS 5/356z.41)

Sec. 356z.41. Cost sharing in prescription insulin drugs; limits; confidentiality of rebate information.

(a) As used in this Section, "prescription insulin drug" means a prescription drug that contains insulin and is used to control blood glucose levels to treat diabetes but does not include an insulin drug that is administered to a patient intravenously.

(b) This Section applies to a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 101st General Assembly.

(c) An insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $35 $100, regardless of the quantity or type of covered prescription insulin drug used to fill the insured's prescription.

(d) Nothing in this Section prevents an insurer from reducing an insured's cost sharing by an amount greater than the amount specified in subsection (c).

(e) The Director may use any of the Director's enforcement powers to obtain an insurer's compliance with this Section.

(f) The Department may adopt rules as necessary to implement and administer this Section and to align it with federal requirements.

(g) On January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor.

(Source: P.A. 101-625, eff. 1-1-21.)

Section 99. Effective date. This Act takes effect upon becoming law.