Rep. Greg Harris
Filed: 3/19/2021
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1 | AMENDMENT TO HOUSE BILL 1745
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2 | AMENDMENT NO. ______. Amend House Bill 1745 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Managed Care Reform and Patient Rights Act | ||||||
5 | is amended by adding Section 45.3 as follows: | ||||||
6 | (215 ILCS 134/45.3 new) | ||||||
7 | Sec. 45.3. Prescription drug benefits; plan choice. | ||||||
8 | (a) Notwithstanding any other provision of law, beginning | ||||||
9 | January 1, 2023, every health insurance carrier that offers an | ||||||
10 | individual health plan that provides coverage for prescription | ||||||
11 | drugs shall ensure that at least 10% of individual health care | ||||||
12 | plans offered in each applicable service area and at each | ||||||
13 | level of coverage as defined in 42 U.S.C. 18022 apply a | ||||||
14 | flat-dollar copayment structure to the entire drug benefit. | ||||||
15 | Beginning January 1, 2024, every health insurance carrier that | ||||||
16 | offers an individual health plan that provides coverage for |
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1 | prescription drugs shall ensure that at least 25% of | ||||||
2 | individual health care plans offered in each applicable | ||||||
3 | service area and at each level of coverage as defined in 42 | ||||||
4 | U.S.C. 18022 apply a flat-dollar copayment structure to the | ||||||
5 | entire drug benefit. If a health insurance carrier offers | ||||||
6 | fewer than 4 plans in a service area, then the health insurance | ||||||
7 | carrier shall ensure that one plan applies a flat-dollar | ||||||
8 | copayment structure to the entire drug benefit. | ||||||
9 | (b) Beginning January 1, 2023, every health insurance | ||||||
10 | carrier that offers a group health plan that provides coverage | ||||||
11 | for prescription drugs shall offer at least one group health | ||||||
12 | plan in each applicable service area and at each level of | ||||||
13 | coverage as defined in 42 U.S.C. 18022 that applies a | ||||||
14 | flat-dollar copayment structure to the entire drug benefit. | ||||||
15 | Beginning January 1, 2024, every health insurance carrier that | ||||||
16 | offers a group health plan that provides coverage for | ||||||
17 | prescription drugs shall offer at least 2 group health plans | ||||||
18 | in each applicable service area and at each level of coverage | ||||||
19 | as defined in 42 U.S.C. 18022 that apply a flat-dollar | ||||||
20 | copayment structure to the entire drug benefit. | ||||||
21 | (c) The flat-dollar copayment structure for prescription | ||||||
22 | drugs under subsections (a) and (b) must be applied | ||||||
23 | pre-deductible and be reasonably graduated and proportionately | ||||||
24 | related in all tier levels such that the copayment structure | ||||||
25 | as a whole does not discriminate against or discourage the | ||||||
26 | enrollment of individuals with significant health care needs. |
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1 | (d) A health insurance carrier that offers individual or | ||||||
2 | group health care plans shall clearly and appropriately name | ||||||
3 | the plans described in subsections (a) and (b) to aid in the | ||||||
4 | individual or group plan selection process. | ||||||
5 | (e) A health insurance carrier shall market plans | ||||||
6 | described in subsections (a) and (b) in the same manner as | ||||||
7 | plans not described in subsections (a) and (b). | ||||||
8 | (f) The Department shall adopt rules necessary to | ||||||
9 | implement and enforce the provisions of this Section.
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10 | Section 99. Effective date. This Act takes effect January | ||||||
11 | 1, 2023.".
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