Illinois General Assembly - Full Text of HB3403
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Full Text of HB3403  102nd General Assembly




State of Illinois
2021 and 2022


Introduced 2/22/2021, by Rep. Suzanne Ness


215 ILCS 5/356z.41
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code to provide that 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 $30 (rather than $100). Makes a conforming change in the Illinois Public Aid Code. Effective immediately.

LRB102 15224 BMS 20579 b






HB3403LRB102 15224 BMS 20579 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.41 as follows:
6    (215 ILCS 5/356z.41)
7    Sec. 356z.41. Cost sharing in prescription insulin drugs;
8limits; confidentiality of rebate information.
9    (a) As used in this Section, "prescription insulin drug"
10means a prescription drug that contains insulin and is used to
11control blood glucose levels to treat diabetes but does not
12include an insulin drug that is administered to a patient
14    (b) This Section applies to a group or individual policy
15of accident and health insurance amended, delivered, issued,
16or renewed on or after the effective date of this amendatory
17Act of the 102nd General Assembly this amendatory Act of the
18101st General Assembly.
19    (c) An insurer that provides coverage for prescription
20insulin drugs pursuant to the terms of a health coverage plan
21the insurer offers shall limit the total amount that an
22insured is required to pay for a 30-day supply of covered
23prescription insulin drugs at an amount not to exceed $30



HB3403- 2 -LRB102 15224 BMS 20579 b

1$100, regardless of the quantity or type of covered
2prescription insulin drug used to fill the insured's
4    (d) Nothing in this Section prevents an insurer from
5reducing an insured's cost sharing by an amount greater than
6the amount specified in subsection (c).
7    (e) The Director may use any of the Director's enforcement
8powers to obtain an insurer's compliance with this Section.
9    (f) The Department may adopt rules as necessary to
10implement and administer this Section and to align it with
11federal requirements.
12    (g) On January 1 of each year, the limit on the amount that
13an insured is required to pay for a 30-day supply of a covered
14prescription insulin drug shall increase by a percentage equal
15to the percentage change from the preceding year in the
16medical care component of the Consumer Price Index of the
17Bureau of Labor Statistics of the United States Department of
19(Source: P.A. 101-625, eff. 1-1-21.)
20    Section 10. The Illinois Public Aid Code is amended by
21changing Section 5-16.8 as follows:
22    (305 ILCS 5/5-16.8)
23    Sec. 5-16.8. Required health benefits. The medical
24assistance program shall (i) provide the post-mastectomy care



HB3403- 3 -LRB102 15224 BMS 20579 b

1benefits required to be covered by a policy of accident and
2health insurance under Section 356t and the coverage required
3under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
4356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of the
5Illinois Insurance Code and (ii) be subject to the provisions
6of Sections 356z.19, 356z.41, 364.01, 370c, and 370c.1 of the
7Illinois Insurance Code.
8    The Department, by rule, shall adopt a model similar to
9the requirements of Section 356z.39 of the Illinois Insurance
11    On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate
14of reimbursement for services or other payments in accordance
15with Section 5-5e.
16    To ensure full access to the benefits set forth in this
17Section, on and after January 1, 2016, the Department shall
18ensure that provider and hospital reimbursement for
19post-mastectomy care benefits required under this Section are
20no lower than the Medicare reimbursement rate.
21(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
22100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
237-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
24eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)
25    Section 99. Effective date. This Act takes effect upon
26becoming law.