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| 1 | AN ACT concerning regulation.
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| 2 | Be it enacted by the People of the State of Illinois,
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| 3 | represented in the General Assembly:
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| 4 | Section 5. The Illinois Insurance Code is amended by | ||||||||||||||||||||||||||
| 5 | changing Section 356z.41 as follows: | ||||||||||||||||||||||||||
| 6 | (215 ILCS 5/356z.41) | ||||||||||||||||||||||||||
| 7 | Sec. 356z.41. Cost sharing in prescription insulin drugs; | ||||||||||||||||||||||||||
| 8 | limits; confidentiality of rebate information. | ||||||||||||||||||||||||||
| 9 | (a) As used in this Section, "prescription insulin drug" | ||||||||||||||||||||||||||
| 10 | means a prescription drug that contains insulin and is used to | ||||||||||||||||||||||||||
| 11 | control blood glucose levels to treat diabetes but does not | ||||||||||||||||||||||||||
| 12 | include an insulin drug that is
administered to a patient | ||||||||||||||||||||||||||
| 13 | intravenously. | ||||||||||||||||||||||||||
| 14 | (b) This Section applies to a group or individual policy | ||||||||||||||||||||||||||
| 15 | of accident and health insurance amended, delivered, issued, | ||||||||||||||||||||||||||
| 16 | or renewed on or after the effective date of this amendatory | ||||||||||||||||||||||||||
| 17 | Act of the 102nd General Assembly this amendatory Act of the | ||||||||||||||||||||||||||
| 18 | 101st General Assembly. | ||||||||||||||||||||||||||
| 19 | (c) An insurer that provides coverage for prescription | ||||||||||||||||||||||||||
| 20 | insulin drugs pursuant to the terms of a health coverage plan | ||||||||||||||||||||||||||
| 21 | the insurer offers shall limit the total amount that an | ||||||||||||||||||||||||||
| 22 | insured is required to pay for a 30-day supply of covered | ||||||||||||||||||||||||||
| 23 | prescription insulin drugs at an amount not to exceed $30 | ||||||||||||||||||||||||||
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| 1 | $100, regardless of the quantity or type of covered | ||||||
| 2 | prescription insulin drug used to fill the insured's | ||||||
| 3 | prescription. | ||||||
| 4 | (d) Nothing in this Section prevents an insurer from | ||||||
| 5 | reducing an insured's cost sharing by an amount greater than | ||||||
| 6 | the amount specified in subsection (c). | ||||||
| 7 | (e) The Director may use any of the Director's enforcement | ||||||
| 8 | powers to obtain an insurer's compliance with this Section. | ||||||
| 9 | (f) The Department may adopt rules as necessary to | ||||||
| 10 | implement and administer this Section and to align it with | ||||||
| 11 | federal requirements. | ||||||
| 12 | (g) On January 1 of each year, the limit on the amount that | ||||||
| 13 | an insured is required to pay for a 30-day supply of a covered | ||||||
| 14 | prescription insulin drug shall increase by a percentage equal | ||||||
| 15 | to the percentage change from the preceding year in the | ||||||
| 16 | medical care component of the Consumer Price Index of the | ||||||
| 17 | Bureau of Labor Statistics of the United States Department of | ||||||
| 18 | Labor.
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| 19 | (Source: P.A. 101-625, eff. 1-1-21.) | ||||||
| 20 | Section 10. The Illinois Public Aid Code is amended by | ||||||
| 21 | changing Section 5-16.8 as follows:
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| 22 | (305 ILCS 5/5-16.8)
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| 23 | Sec. 5-16.8. Required health benefits. The medical | ||||||
| 24 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
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| 1 | benefits required to be covered by a policy of
accident and | ||||||
| 2 | health insurance under Section 356t and the coverage required
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| 3 | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, | ||||||
| 4 | 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of the | ||||||
| 5 | Illinois
Insurance Code and (ii) be subject to the provisions | ||||||
| 6 | of Sections 356z.19, 356z.41, 364.01, 370c, and 370c.1 of the | ||||||
| 7 | Illinois
Insurance Code.
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| 8 | The Department, by rule, shall adopt a model similar to | ||||||
| 9 | the requirements of Section 356z.39 of the Illinois Insurance | ||||||
| 10 | Code. | ||||||
| 11 | On and after July 1, 2012, the Department shall reduce any | ||||||
| 12 | rate of reimbursement for services or other payments or alter | ||||||
| 13 | any methodologies authorized by this Code to reduce any rate | ||||||
| 14 | of reimbursement for services or other payments in accordance | ||||||
| 15 | with Section 5-5e. | ||||||
| 16 | To ensure full access to the benefits set forth in this | ||||||
| 17 | Section, on and after January 1, 2016, the Department shall | ||||||
| 18 | ensure that provider and hospital reimbursement for | ||||||
| 19 | post-mastectomy care benefits required under this Section are | ||||||
| 20 | no lower than the Medicare reimbursement rate. | ||||||
| 21 | (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; | ||||||
| 22 | 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. | ||||||
| 23 | 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, | ||||||
| 24 | eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)
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| 25 | Section 99. Effective date. This Act takes effect upon | ||||||
| 26 | becoming law.
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