Illinois General Assembly - Illinois Compiled Statutes

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215 ILCS 5/356z.5

    (215 ILCS 5/356z.5)
    (Text of Section before amendment by P.A. 103-951)
    Sec. 356z.5. Prescription inhalants.

A group or individual
policy of
accident and health insurance or managed care plan amended, delivered, issued,
or renewed
after the effective date of this amendatory Act of the 93rd General Assembly
that provides
coverage for prescription drugs may not deny or limit coverage
for prescription inhalants to enable persons to breathe when suffering from
asthma or other life-threatening bronchial ailments based upon any restriction
on the number of days before an inhaler refill may be obtained if, contrary to
those restrictions, the inhalants have been ordered or prescribed by the
treating physician and are medically appropriate.

(Source: P.A. 95-331, eff. 8-21-07.)

    (Text of Section after amendment by P.A. 103-951)
    Sec. 356z.5. Prescription inhalants.

(a) In this Section, "prescription inhaler" means a prescribed medical device that delivers inhaled medications used to treat breathing for persons suffering from asthma or other life-threatening bronchial ailments. "Prescription inhaler" includes metered-dose inhalers, nebulizers, and dry powder inhalers. "Prescription inhaler" does not include inhalers available over the counter without a prescription to provide temporary relief from respiratory symptoms.

(b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed through December 31, 2025 that provides coverage for prescription drugs may not deny or limit coverage for prescription inhalers to enable persons to breathe when suffering from asthma or other life-threatening bronchial ailments based upon any restriction on the number of days before an inhaler refill may be obtained if, contrary to those restrictions, the inhalants have been ordered or prescribed by the treating physician and are medically appropriate.

(c) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides coverage for prescription drugs may not deny or limit, except as otherwise provided in this subsection, coverage for prescription inhalers to enable persons to breathe when suffering from asthma or other life-threatening bronchial ailments based upon any restriction on the number of days before an inhaler refill may be obtained if, contrary to those restrictions, the inhalants have been ordered or prescribed by the treating physician and are medically appropriate. A group or individual policy of accident and health insurance or managed care plan subject to this subsection shall limit the total amount that a covered person is required to pay for a covered prescription inhaler to an amount not to exceed $25 per 30-day supply.

(d) Nothing in this Section prevents a group or individual policy of accident and health insurance or managed care plan from reducing a covered person's cost sharing to an amount less than the amount specified in subsection (c).

(e) Coverage for prescription inhalers shall not be subject to any deductible; except that this provision does not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code (26 U.S.C. 223).

(f) The Department may adopt rules necessary to implement and administer this Section and to align with federal requirements. The Department may use any of its enforcement powers to obtain a group or individual policy of accident and health insurance's or managed care plan's compliance with this Section.

(Source: P.A. 103-951, eff. 1-1-25.)