Full Text of HB0152 96th General Assembly
HB0152enr 96TH GENERAL ASSEMBLY
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HB0152 Enrolled |
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| AN ACT concerning insurance.
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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 1. Short title. This Act may be cited as the Organ | 5 |
| Transplant Medication Notification Act. | 6 |
| Section 5. Applicability. This Act shall apply solely to | 7 |
| cases of immunosuppressive therapy when (i) an | 8 |
| immunosuppressant drug has been prescribed to a patient to | 9 |
| prevent the rejection of transplanted organs and
tissues and | 10 |
| (ii) as set forth in Section 15 of this Act, a prescribing | 11 |
| physician has indicated on a prescription "may not substitute". | 12 |
| This Act does not apply to medication orders issued for | 13 |
| immunosuppressant drugs for any in-patient care in a licensed | 14 |
| hospital. | 15 |
| Section 10. Definitions. For the purpose of this Act: | 16 |
| "Health insurance policy or health care service plan" means | 17 |
| any policy of health or accident insurance subject to the | 18 |
| provisions of the Illinois Insurance Code, Health Maintenance | 19 |
| Organization Act, Voluntary Health Services Plan Act, Counties | 20 |
| Code, Municipal Code, School Code, and State Employees Group | 21 |
| Insurance Act. | 22 |
| "Immunosuppressant drugs" mean drugs that are used in |
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| immunosuppressive therapy to inhibit or prevent the activity of | 2 |
| the immune system. "Immunosuppressant drugs" are used | 3 |
| clinically to prevent the rejection of transplanted organs and | 4 |
| tissues. "Immunosuppressant drugs" do not include drugs for the | 5 |
| treatment of autoimmune diseases or diseases that are most | 6 |
| likely of autoimmune origin. | 7 |
| Section 15. Quality assurance in patient care. In | 8 |
| accordance with the Pharmacy Practice Act, when a prescribing | 9 |
| physician has indicated on a prescription "may not substitute", | 10 |
| a health insurance policy or health care service plan that | 11 |
| covers immunosuppressant drugs may not require or cause a | 12 |
| pharmacist to interchange another immunosuppressant drug or | 13 |
| formulation issued on behalf of a person to inhibit or prevent | 14 |
| the activity of the immune system of a patient to prevent the | 15 |
| rejection of transplanted organs and tissues without | 16 |
| notification and the documented consent of the prescribing | 17 |
| physician and the patient, or the parent or guardian if the | 18 |
| patient is a child, or the spouse of a patient who is | 19 |
| authorized to consent to the treatment of the person. | 20 |
| Except as provided by subsections (a), (b), and (c) of | 21 |
| Section 20 of this Act, patient co-payments, deductibles, or | 22 |
| other
charges for the prescribed drug for which another | 23 |
| immunosuppressant drug or formulation is not interchanged | 24 |
| shall remain the same for the enrollment period established by | 25 |
| the health insurance policy or plan.
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| Section 20. Provision of notice; formulary changes. | 2 |
| (a) At least 60 days prior to making any formulary change | 3 |
| that alters the terms of coverage for a patient receiving | 4 |
| immunosuppressant drugs or discontinues coverage for a | 5 |
| prescribed immunosuppressant drug that a patient is receiving, | 6 |
| a policy or plan sponsor must, to the extent possible, notify | 7 |
| the prescribing physician and the patient, or the parent or | 8 |
| guardian if the patient is a child, or the spouse of a patient | 9 |
| who is authorized to consent to the treatment of the patient. | 10 |
| The notification shall be in writing and shall disclose the | 11 |
| formulary change, indicate that the prescribing physician may | 12 |
| initiate an appeal, and include information regarding the | 13 |
| procedure for the prescribing physician to initiate the policy | 14 |
| or plan sponsor's appeal process. | 15 |
| (b) As an alternative to providing written notice, a policy | 16 |
| or plan sponsor may provide the notice electronically if, and | 17 |
| only if, the patient affirmatively elects to receive such | 18 |
| notice electronically. The notification shall disclose the | 19 |
| formulary change, indicate that the prescribing physician may | 20 |
| initiate an appeal, and include information regarding the | 21 |
| procedure for the prescribing physician to initiate the policy | 22 |
| or plan sponsor's appeal process. | 23 |
| (c) At the time a patient requests a refill of the | 24 |
| immunosuppressant drug, a policy or plan sponsor may provide | 25 |
| the patient with the written notification required under |
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| subsection (a) of this Section along with a 60-day supply of | 2 |
| the immunosuppressant drug under the same terms as previously | 3 |
| allowed. | 4 |
| (d) Nothing in this Section shall prohibit insurers or | 5 |
| pharmacy benefit managers from using managed pharmacy care | 6 |
| tools, including, but not limited to, formulary tiers, generic | 7 |
| substitution, therapeutic interchange, prior authorization, or | 8 |
| step therapy, so long as an exception process is in place | 9 |
| allowing the prescriber to petition for coverage of a | 10 |
| non-preferred drug if sufficient clinical reasons justify an | 11 |
| exception to the normal protocol. |
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