Full Text of HB1466 102nd General Assembly
HB1466ham001 102ND GENERAL ASSEMBLY | Rep. Will Guzzardi Filed: 4/4/2022
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| 1 | | AMENDMENT TO HOUSE BILL 1466
| 2 | | AMENDMENT NO. ______. Amend House Bill 1466 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Access to Affordable Insulin Act. | 6 | | Section 5. Definitions. As used in this Act:
| 7 | | "Department" means the Department of Public Health.
| 8 | | "Insulin" means a prescription drug that contains insulin.
| 9 | | "Manufacturer" means a manufacturer engaged in the | 10 | | manufacturing of insulin that is self-administered on an | 11 | | outpatient basis.
| 12 | | "Navigator" has the meaning described in Section 1311(i) | 13 | | of the Patient Protection and Affordable Care Act, Public Law | 14 | | 111-148, and further defined through amendments to that Act | 15 | | and regulations issued under that Act.
| 16 | | "Pharmacy" means a pharmacy located in this State.
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| 1 | | "Prescription drug" means a drug that is required by | 2 | | federal or State law or rule to be dispensed only by | 3 | | prescription or that is restricted to administration only by | 4 | | practitioners.
| 5 | | "Urgent need of insulin" means having readily available | 6 | | for use less than a 7-day supply of insulin and in need of | 7 | | insulin in order to avoid the likelihood of suffering | 8 | | significant health consequences.
| 9 | | Section 10. Insulin urgent-need program.
| 10 | | (a) To be eligible to receive an urgent-need supply of | 11 | | insulin under this Section, an individual must attest to:
| 12 | | (1) being a resident of this State;
| 13 | | (2) not being enrolled in a medical assistance program | 14 | | under the Illinois Public Aid Code;
| 15 | | (3) not being enrolled in prescription drug coverage | 16 | | that limits the total amount of cost sharing that the | 17 | | enrollee is required to pay for a 30-day supply of | 18 | | insulin, including copayments, deductibles, or
| 19 | | coinsurance, to $35 or less, regardless of the type or | 20 | | amount of insulin prescribed;
| 21 | | (4) not having received an urgent-need supply of | 22 | | insulin through this program within the previous 12 | 23 | | months, unless authorized under subsection (m) or (n); and
| 24 | | (5) being in urgent need of insulin.
| 25 | | (b) The Department shall develop an application form to be |
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| 1 | | used by an individual who is in urgent need of insulin. The | 2 | | application must ask the individual to attest to the | 3 | | eligibility requirements described in subsection (a). The form | 4 | | shall be accessible through the Department's website. The | 5 | | Department shall also make the form available to pharmacies | 6 | | and health care providers who prescribe or dispense insulin, | 7 | | hospital emergency departments, urgent care clinics, and | 8 | | community health clinics. By submitting a completed, signed, | 9 | | and dated application to a pharmacy, the individual attests | 10 | | that the information contained in the application is correct.
| 11 | | (c) If an individual is in urgent need of insulin, the | 12 | | individual may present a completed, signed, and dated | 13 | | application form to a pharmacy. The individual must also:
| 14 | | (1) have a valid insulin prescription; and
| 15 | | (2) present the pharmacist with identification | 16 | | indicating Illinois residency in the form of a valid | 17 | | Illinois identification card, driver's license, or permit; | 18 | | if the individual in urgent need of insulin is under the | 19 | | age of 18, the individual's parent or legal guardian must | 20 | | provide the pharmacist with proof of residency.
| 21 | | (d) Upon receipt of a completed and signed application, a | 22 | | pharmacist shall dispense the prescribed insulin in an amount | 23 | | that will provide the individual with a 30-day supply. The | 24 | | pharmacy shall notify the health care practitioner who issued | 25 | | the prescription order no later than 72 hours after the | 26 | | insulin is dispensed.
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| 1 | | (e) A pharmacy may submit to the manufacturer of the | 2 | | dispensed insulin product or to the manufacturer's vendor a | 3 | | claim for payment that is in accordance with the National | 4 | | Council for Prescription Drug Program standards for electronic | 5 | | claims processing, unless the manufacturer agrees to send to | 6 | | the pharmacy a replacement supply of the same insulin as | 7 | | dispensed in the amount dispensed. If the pharmacy submits an | 8 | | electronic claim to the manufacturer or the manufacturer's | 9 | | vendor, the manufacturer or vendor shall reimburse the | 10 | | pharmacy in an amount that covers the pharmacy's acquisition
| 11 | | cost.
| 12 | | (f) A pharmacy may collect an insulin copayment from an | 13 | | individual to cover the pharmacy's costs of processing and | 14 | | dispensing in an amount not to exceed $35 for the 30-day supply | 15 | | of insulin dispensed.
| 16 | | (g) The pharmacy shall also provide each eligible | 17 | | individual with the information sheet described in subsection | 18 | | (i) and a list of trained navigators provided by the | 19 | | Department for the individual to contact if the individual is | 20 | | in need of accessing ongoing insulin coverage options, | 21 | | including assistance in:
| 22 | | (1) applying for medical assistance;
| 23 | | (2) applying for a qualified health plan, subject to | 24 | | open and special enrollment periods;
| 25 | | (3) accessing information on providers who participate | 26 | | in prescription drug discount programs, including |
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| 1 | | providers who are authorized to participate in the 340B | 2 | | program under Section 340b of the Public Health Services | 3 | | Act, Section 256b of Title 42 of the United States Code; | 4 | | and
| 5 | | (4) accessing insulin manufacturers' copayment | 6 | | assistance programs and other foundation-based programs.
| 7 | | (h) A pharmacist shall retain a copy of the application | 8 | | form submitted by the individual to the pharmacy for reporting | 9 | | and auditing purposes.
| 10 | | (i) The Department shall develop an information sheet to | 11 | | post on its website and provide a link to the information sheet | 12 | | on the board's website for pharmacies, health care | 13 | | practitioners, hospital emergency departments, urgent care | 14 | | clinics, and community health clinics. The information sheet
| 15 | | shall contain:
| 16 | | (1) a description of the urgent-need insulin program, | 17 | | including how to access the program;
| 18 | | (2) a description of each insulin manufacturer's | 19 | | cost-sharing assistance program, including contact | 20 | | information on accessing the assistance program for each | 21 | | manufacturer;
| 22 | | (3) information on how to contact a trained navigator | 23 | | for assistance in applying for medical assistance or a | 24 | | qualified health plan;
and | 25 | | (4) notification that an individual in need of | 26 | | assistance may contact the individual's local county |
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| 1 | | social service department for more information or | 2 | | assistance in accessing ongoing affordable insulin | 3 | | options.
| 4 | | (j) The Department shall also inform each individual who | 5 | | accesses urgent-need insulin under this Section that the | 6 | | individual may participate in a survey conducted by the | 7 | | Department regarding satisfaction with the program. The | 8 | | Department shall provide contact information for the | 9 | | individual to learn more about the survey and how to | 10 | | participate. This information may be included on the | 11 | | information sheet described in subsection (i).
| 12 | | (k) The Department shall develop a training program for | 13 | | navigators to provide navigators with information and | 14 | | resources necessary to assist individuals in accessing | 15 | | appropriate long-term insulin options.
| 16 | | (l) The Department shall compile a list of navigators who | 17 | | have completed the training program and who are available to | 18 | | assist individuals in accessing affordable insulin coverage | 19 | | options. The list shall be made available through the | 20 | | Department's website and to pharmacies and health care | 21 | | practitioners who dispense and prescribe insulin.
| 22 | | (m) If an individual has applied for the medical | 23 | | assistance program under the Illinois Public Aid Code but has | 24 | | not been determined eligible or has been determined eligible | 25 | | but coverage has not become effective, the individual may | 26 | | access urgent-need insulin if the individual is in urgent need |
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| 1 | | of insulin as defined in Section 5.
| 2 | | (n) To access an additional 30-day supply of insulin, an | 3 | | individual must attest to the pharmacy that the individual | 4 | | meets the requirements of subsection (m) and must comply with | 5 | | subsection (c). | 6 | | Section 90. The Illinois Insurance Code is amended by | 7 | | changing Section 356z.41 as follows: | 8 | | (215 ILCS 5/356z.41) | 9 | | Sec. 356z.41. Cost sharing in prescription insulin drugs; | 10 | | limits; confidentiality of rebate information. | 11 | | (a) As used in this Section, "prescription insulin drug" | 12 | | means a prescription drug that contains insulin and is used to | 13 | | control blood glucose levels to treat diabetes but does not | 14 | | include an insulin drug that is
administered to a patient | 15 | | intravenously. | 16 | | (b) This Section applies to a group or individual policy | 17 | | of accident and health insurance amended, delivered, issued, | 18 | | or renewed on or after the effective date of this amendatory | 19 | | Act of the 101st General Assembly. | 20 | | (c) An insurer that provides coverage for prescription | 21 | | insulin drugs pursuant to the terms of a health coverage plan | 22 | | the insurer offers shall limit the total amount that an | 23 | | insured is required to pay for a 30-day supply of covered | 24 | | prescription insulin drugs at an amount not to exceed $35 |
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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.
| 19 | | (Source: P.A. 101-625, eff. 1-1-21 .)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.".
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