Illinois 2023-2024 Regular Session

Illinois House Bill HB1348 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1348 Introduced , by Rep. Lakesia Collins SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.60 new215 ILCS 5/513b7 new Amends the Illinois Insurance Code. Provides that no later than July 1, 2024, each health plan and pharmacy benefit manager operating in this State shall, upon request of a covered individual, his or her health care provider, or an authorized third party on his or her behalf, furnish specified cost, benefit, and coverage data to the covered individual, his or her health care provider, or the third party of his or her choosing and shall ensure that the data is: (1) current no later than one business day after any change is made; (2) provided in real time; and (3) in a format that is easily accessible to the covered individual or, in the case of his or her health care provider, through an electronic health records system. Provides that the format of the request shall use specified industry content and transport standards. Provides that a facsimile is not an acceptable electronic format. Provides that upon request, specified data shall be provided for any drug covered under the covered individual's health plan. Makes other changes. Defines terms. LRB103 05999 BMS 51023 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1348 Introduced , by Rep. Lakesia Collins SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.60 new215 ILCS 5/513b7 new 215 ILCS 5/356z.60 new 215 ILCS 5/513b7 new Amends the Illinois Insurance Code. Provides that no later than July 1, 2024, each health plan and pharmacy benefit manager operating in this State shall, upon request of a covered individual, his or her health care provider, or an authorized third party on his or her behalf, furnish specified cost, benefit, and coverage data to the covered individual, his or her health care provider, or the third party of his or her choosing and shall ensure that the data is: (1) current no later than one business day after any change is made; (2) provided in real time; and (3) in a format that is easily accessible to the covered individual or, in the case of his or her health care provider, through an electronic health records system. Provides that the format of the request shall use specified industry content and transport standards. Provides that a facsimile is not an acceptable electronic format. Provides that upon request, specified data shall be provided for any drug covered under the covered individual's health plan. Makes other changes. Defines terms. LRB103 05999 BMS 51023 b LRB103 05999 BMS 51023 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1348 Introduced , by Rep. Lakesia Collins SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356z.60 new215 ILCS 5/513b7 new 215 ILCS 5/356z.60 new 215 ILCS 5/513b7 new
4	4	215 ILCS 5/356z.60 new
5	5	215 ILCS 5/513b7 new
6	6	Amends the Illinois Insurance Code. Provides that no later than July 1, 2024, each health plan and pharmacy benefit manager operating in this State shall, upon request of a covered individual, his or her health care provider, or an authorized third party on his or her behalf, furnish specified cost, benefit, and coverage data to the covered individual, his or her health care provider, or the third party of his or her choosing and shall ensure that the data is: (1) current no later than one business day after any change is made; (2) provided in real time; and (3) in a format that is easily accessible to the covered individual or, in the case of his or her health care provider, through an electronic health records system. Provides that the format of the request shall use specified industry content and transport standards. Provides that a facsimile is not an acceptable electronic format. Provides that upon request, specified data shall be provided for any drug covered under the covered individual's health plan. Makes other changes. Defines terms.
7	7	LRB103 05999 BMS 51023 b LRB103 05999 BMS 51023 b
8	8	LRB103 05999 BMS 51023 b
9	9	A BILL FOR
10	10	HB1348LRB103 05999 BMS 51023 b HB1348 LRB103 05999 BMS 51023 b
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12	12	1 AN ACT concerning regulation.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 5. The Illinois Insurance Code is amended by
16	16	5 adding Sections 356z.60 and 513b7 as follows:
17	17	6 (215 ILCS 5/356z.60 new)
18	18	7 Sec. 356z.60. Patient prescription pricing transparency.
19	19	8 (a) As used in this Section:
20	20	9 "Authorized third party" includes a third party legally
21	21	10 authorized under State or federal law subject to a Health
22	22	11 Insurance Portability and Accountability Act of 1996 business
23	23	12 associate agreement.
24	24	13 "Cost-sharing information" means the amount a covered
25	25	14 individual is required to pay to receive a drug that is covered
26	26	15 under the covered individual's health plan.
27	27	16 "Coverage" means those health care services to which a
28	28	17 covered individual is entitled under the terms of the health
29	29	18 plan.
30	30	19 "Electronic health record" means a digital version of a
31	31	20 patient's paper chart and medical history that makes
32	32	21 information available instantly and securely to authorized
33	33	22 users.
34	34	23 "Electronic prescribing system" means a system that
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1348 Introduced , by Rep. Lakesia Collins SYNOPSIS AS INTRODUCED:
39	39	215 ILCS 5/356z.60 new215 ILCS 5/513b7 new 215 ILCS 5/356z.60 new 215 ILCS 5/513b7 new
40	40	215 ILCS 5/356z.60 new
41	41	215 ILCS 5/513b7 new
42	42	Amends the Illinois Insurance Code. Provides that no later than July 1, 2024, each health plan and pharmacy benefit manager operating in this State shall, upon request of a covered individual, his or her health care provider, or an authorized third party on his or her behalf, furnish specified cost, benefit, and coverage data to the covered individual, his or her health care provider, or the third party of his or her choosing and shall ensure that the data is: (1) current no later than one business day after any change is made; (2) provided in real time; and (3) in a format that is easily accessible to the covered individual or, in the case of his or her health care provider, through an electronic health records system. Provides that the format of the request shall use specified industry content and transport standards. Provides that a facsimile is not an acceptable electronic format. Provides that upon request, specified data shall be provided for any drug covered under the covered individual's health plan. Makes other changes. Defines terms.
43	43	LRB103 05999 BMS 51023 b LRB103 05999 BMS 51023 b
44	44	LRB103 05999 BMS 51023 b
45	45	A BILL FOR
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51	51	215 ILCS 5/356z.60 new
52	52	215 ILCS 5/513b7 new
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71	71	1 enables prescribers to enter prescription information into a
72	72	2 computer prescription device and securely transmit the
73	73	3 prescription to pharmacies using a special software program
74	74	4 and connectivity to a transmission network.
75	75	5 "Prescriber" means a health care provider licensed to
76	76	6 prescribe medication or medical devices in this State.
77	77	7 "Real-time benefit tool" means an electronic prescription
78	78	8 decision support tool that (i) is capable of integrating with
79	79	9 prescribers' electronic prescribing and, if feasible,
80	80	10 electronic health record systems; and (ii) complies with the
81	81	11 technical standards adopted by an American National Standards
82	82	12 Institute accredited standards development organization.
83	83	13 (b) No later than July 1, 2024, each health plan operating
84	84	14 in this State shall, upon request of a covered individual, his
85	85	15 or her health care provider, or an authorized third party on
86	86	16 his or her behalf, furnish the cost, benefit, and coverage
87	87	17 data required under this Section to the covered individual,
88	88	18 his or her health care provider, or the third party of his or
89	89	19 her choosing and shall ensure that the data is:
90	90	20 (1) current no later than one business day after any
91	91	21 change is made;
92	92	22 (2) provided in real time; and
93	93	23 (3) in a format that is easily accessible to the
94	94	24 covered individual or, in the case of his or her health
95	95	25 care provider, through an electronic health records
96	96	26 system.
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107	107	1 (c) The format of the request shall use established
108	108	2 industry content and transport standards published by:
109	109	3 (1) a standards developing organization accredited by
110	110	4 the American National Standards Institute, including the
111	111	5 National Council for Prescription Drug Programs,
112	112	6 Accredited Standards Committee X12, and Health Level 7;
113	113	7 (2) a relevant federal or state governing body,
114	114	8 including the Centers for Medicare & Medicaid Services or
115	115	9 the Office of the National Coordinator for Health
116	116	10 Information Technology; or
117	117	11 (3) another format deemed acceptable to the Department
118	118	12 that provides the data described in subsection (a) and
119	119	13 with the same timeliness as required by this Section.
120	120	14 (d) A facsimile is not an acceptable electronic format
121	121	15 under this Section.
122	122	16 (e) Upon request, the following data shall be provided for
123	123	17 any drug covered under the covered individual's health plan:
124	124	18 (1) patient-specific eligibility information;
125	125	19 (2) patient-specific prescription cost and benefit
126	126	20 data, such as applicable formulary, benefit, coverage and
127	127	21 cost-sharing data for the prescribed drug, and clinically
128	128	22 appropriate alternatives, when appropriate;
129	129	23 (3) patient-specific cost-sharing information that
130	130	24 describes variance in cost sharing based on the pharmacy
131	131	25 dispensing the prescribed drug or its alternatives, and in
132	132	26 relation to the patient's benefit, such as spending
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143	143	1 related to the out-of-pocket maximum;
144	144	2 (4) information regarding lower cost clinically
145	145	3 appropriate treatment alternatives; and
146	146	4 (5) applicable utilization management requirements.
147	147	5 (f) Any health plan shall furnish the data as required
148	148	6 whether the request is made using the drug's unique billing
149	149	7 code, such as a National Drug Code or Healthcare Common
150	150	8 Procedure Coding System code, or descriptive term. A health
151	151	9 plan shall not deny or unreasonably delay a request as a method
152	152	10 of blocking the required data from being shared based on how
153	153	11 the drug was requested.
154	154	12 (g) A health plan shall not restrict, prohibit, or
155	155	13 otherwise hinder the prescriber from communicating or sharing
156	156	14 benefit and coverage information that reflects other choices,
157	157	15 such as cash price, lower cost clinically appropriate
158	158	16 alternatives, whether or not they are covered under the
159	159	17 covered individual's plan and support programs, and the cost
160	160	18 available at the patient's pharmacy of choice.
161	161	19 (h) A health plan shall not, except as may be required by
162	162	20 law, interfere with, prevent, or materially discourage access,
163	163	21 exchange, or use of the data as required, which may include
164	164	22 charging fees or not responding to a request for such data in a
165	165	23 reasonable time frame; nor penalize a health care provider or
166	166	24 professional for disclosing such information to a covered
167	167	25 individual or legally prescribing, administering, or ordering
168	168	26 a clinically appropriate or lower cost alternative.
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179	179	1 (i) Nothing in this Section shall be construed to limit
180	180	2 access to the most up-to-date patient-specific eligibility or
181	181	3 patient-specific prescription cost and benefit data by the
182	182	4 health plan.
183	183	5 (j) Nothing in this Section shall interfere with patient
184	184	6 choice and a health care professional's ability to convey the
185	185	7 full range of prescription drug cost options to a patient.
186	186	8 Health plans shall not restrict a health care professional
187	187	9 from communicating prescription cost options to the patient.
188	188	10 (k) No real-time benefit tool shall require a patient to
189	189	11 use specific plan-preferred drugs or pharmacies.
190	190	12 (215 ILCS 5/513b7 new)
191	191	13 Sec. 513b7. Patient prescription pricing transparency.
192	192	14 (a) No later than July 1, 2024, each pharmacy benefit
193	193	15 manager operating in this State shall, upon request of a
194	194	16 covered individual, his or her health care provider, or an
195	195	17 authorized third party on his or her behalf, furnish the cost,
196	196	18 benefit, and coverage data required under this Section to the
197	197	19 covered individual, his or her health care provider, or the
198	198	20 third party of his or her choosing and shall ensure that the
199	199	21 data is:
200	200	22 (1) current no later than one business day after any
201	201	23 change is made;
202	202	24 (2) provided in real time; and
203	203	25 (3) in a format that is easily accessible to the
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214	214	1 covered individual or, in the case of his or her health
215	215	2 care provider, through an electronic health records
216	216	3 system.
217	217	4 (b) The format of the request shall use established
218	218	5 industry content and transport standards published by:
219	219	6 (1) a standards developing organization accredited by
220	220	7 the American National Standards Institute, including the
221	221	8 National Council for Prescription Drug Programs,
222	222	9 Accredited Standards Committee X12, and Health Level 7;
223	223	10 (2) a relevant federal or state governing body,
224	224	11 including the Centers for Medicare & Medicaid Services or
225	225	12 the Office of the National Coordinator for Health
226	226	13 Information Technology; or
227	227	14 (3) another format deemed acceptable to the Department
228	228	15 that provides the data described in subsection (a) and
229	229	16 with the same timeliness as required by this Section.
230	230	17 (c) A facsimile is not an acceptable electronic format
231	231	18 under this Section.
232	232	19 (d) Upon request, the following data shall be provided for
233	233	20 any drug covered under the covered individual's health plan:
234	234	21 (1) patient-specific eligibility information;
235	235	22 (2) patient-specific prescription cost and benefit
236	236	23 data, such as applicable formulary, benefit, coverage and
237	237	24 cost-sharing data for the prescribed drug, and clinically
238	238	25 appropriate alternatives, when appropriate;
239	239	26 (3) patient-specific cost-sharing information that
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250	250	1 describes variance in cost sharing based on the pharmacy
251	251	2 dispensing the prescribed drug or its alternatives, and in
252	252	3 relation to the patient's benefit, such as spending
253	253	4 related to the out-of-pocket maximum;
254	254	5 (4) information regarding lower cost clinically
255	255	6 appropriate treatment alternatives; and
256	256	7 (5) applicable utilization management requirements.
257	257	8 (e) A pharmacy benefit manager shall furnish the data as
258	258	9 required whether the request is made using the drug's unique
259	259	10 billing code, such as a National Drug Code or Healthcare
260	260	11 Common Procedure Coding System code, or descriptive term. A
261	261	12 pharmacy benefit manager shall not deny or unreasonably delay
262	262	13 a request as a method of blocking the required data from being
263	263	14 shared based on how the drug was requested.
264	264	15 (f) A pharmacy benefit manager shall not restrict,
265	265	16 prohibit, or otherwise hinder the prescriber from
266	266	17 communicating or sharing benefit and coverage information that
267	267	18 reflects other choices, such as cash price, lower cost
268	268	19 clinically appropriate alternatives, whether or not they are
269	269	20 covered under the covered individual's plan, patient
270	270	21 assistance programs, and support programs, and the cost
271	271	22 available at the patient's pharmacy of choice.
272	272	23 (g) A pharmacy benefit manager shall not, except as may be
273	273	24 required by law, interfere with, prevent, or materially
274	274	25 discourage access, exchange, or use of the data as required,
275	275	26 which may include charging fees or not responding to a request
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286	286	1 for such data in a reasonable time frame; nor penalize a health
287	287	2 care provider or professional for disclosing such information
288	288	3 to a covered individual or legally prescribing, administering,
289	289	4 or ordering a clinically appropriate or lower cost
290	290	5 alternative.
291	291	6 (h) Nothing in this Section shall be construed to limit
292	292	7 access to the most up-to-date patient-specific eligibility or
293	293	8 patient-specific prescription cost and benefit data by the
294	294	9 pharmacy benefit manager.
295	295	10 (i) Nothing in this Section shall interfere with patient
296	296	11 choice and a health care professional's ability to convey the
297	297	12 full range of prescription drug cost options to a patient. A
298	298	13 pharmacy benefit manager shall not restrict a health care
299	299	14 professional from communicating prescription cost options to
300	300	15 the patient.
301	301	16 (j) No real-time benefit tool shall require a patient to
302	302	17 use specific plan-preferred drugs or pharmacies.
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