<tr><td class="xsl" colspan="3"><p> </p> </td></tr></td></tr><tr><td class="xsl" colspan="3"><table class="xsl" width="100%"><colgroup width="5%"></colgroup><colgroup width="5%"></colgroup><colgroup width="30%"></colgroup><colgroup width="20%"></colgroup><colgroup width="40%"></colgroup><tr><td class="number"></td><td class="junk"></td><td class="xsl" align="left">HB2584 Engrossed</td><td class="xsl" align="center"></td><td class="xsl" align="right">LRB104 08321 BAB 18372 b</td></tr></table></td></tr><tr><td class="xsl"> </td></tr><tr><td class="number">1</td><td class="junk"></td><td class="xsl" ><code> </code><code>AN ACT concerning regulation.</code> </td></tr><tr><td class="number">2</td><td class="junk"></td><td class="xsl" ><code> </code><b><code>Be it enacted by the People of the State of Illinois, </code></b></td></tr><tr><td class="number">3</td><td class="junk"></td><td class="xsl" ><b><code>represented in the General Assembly:</code></b> </td></tr><tr><td class="number">4</td><td class="junk"></td><td class="xsl" ><code> </code><code>Section 5. </code><code>The Illinois Insurance Code is amended by </code></td></tr><tr><td class="number">5</td><td class="junk"></td><td class="xsl" ><code>changing Section 356z.60 as follows:</code> </td></tr><tr><td class="number">6</td><td class="junk"></td><td class="xsl" ><code> </code><code>(215 ILCS 5/356z.60)</code></td></tr><tr><td class="number">7</td><td class="junk"></td><td class="xsl" ><code> </code><code>Sec. 356z.60. </code><code>Coverage for abortifacients, hormonal </code></td></tr><tr><td class="number">8</td><td class="junk"></td><td class="xsl" ><code>therapy, and human immunodeficiency virus pre-exposure </code></td></tr><tr><td class="number">9</td><td class="junk"></td><td class="xsl" ><code>prophylaxis and post-exposure prophylaxis.</code></td></tr><tr><td class="number">10</td><td class="junk"></td><td class="xsl" ><code> </code><code>(a) As used in this Section:</code></td></tr><tr><td class="number">11</td><td class="junk"></td><td class="xsl" ><code> </code><code>"Abortifacients" means any medication administered to </code></td></tr><tr><td class="number">12</td><td class="junk"></td><td class="xsl" ><code>terminate a pregnancy as prescribed or ordered by a health </code></td></tr><tr><td class="number">13</td><td class="junk"></td><td class="xsl" ><code>care professional.</code></td></tr><tr><td class="number">14</td><td class="junk"></td><td class="xsl" ><code> </code><code>"Health care professional" means a physician licensed to </code></td></tr><tr><td class="number">15</td><td class="junk"></td><td class="xsl" ><code>practice medicine in all of its branches, licensed advanced </code></td></tr><tr><td class="number">16</td><td class="junk"></td><td class="xsl" ><code>practice registered nurse, or physician assistant.</code></td></tr><tr><td class="number">17</td><td class="junk"></td><td class="xsl" ><code> </code><code>"Hormonal therapy medication" means hormonal treatment </code></td></tr><tr><td class="number">18</td><td class="junk"></td><td class="xsl" ><code>administered to treat gender dysphoria.</code></td></tr><tr><td class="number">19</td><td class="junk"></td><td class="xsl" ><code> </code><code>"Therapeutic equivalent version" means drugs, devices, or </code></td></tr><tr><td class="number">20</td><td class="junk"></td><td class="xsl" ><code>products that can be expected to have the same clinical effect </code></td></tr><tr><td class="number">21</td><td class="junk"></td><td class="xsl" ><code>and safety profile when administered to patients under the </code></td></tr><tr><td class="number">22</td><td class="junk"></td><td class="xsl" ><code>conditions specified in the labeling and that satisfy the </code></td></tr><tr><td class="number">23</td><td class="junk"></td><td class="xsl" ><code>following general criteria:</code></td></tr></table><table class="xsl" width="650"><tr><td class="lineNum" colspan="3"><p> </p><p> </p></td></tr><tr><td class="xsl" colspan="3"><table class="xsl" width="100%"><colgroup width="5%"></colgroup><colgroup width="5%"></colgroup><colgroup width="30%"></colgroup><colgroup width="20%"></colgroup><colgroup width="40%"></colgroup><tr><td class="number"></td><td class="junk"></td><td class="xsl" align="left">HB2584 Engrossed</td><td class="xsl" align="center">- 2 -</td><td class="xsl" align="right">LRB104 08321 BAB 18372 b</td></tr></table></td></tr><tr><td class="xsl"> </td></tr><tr><td class="number">1</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(1) it is approved as safe and effective;</code></td></tr><tr><td class="number">2</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(2) it is a pharmaceutical equivalent in that it:</code></td></tr><tr><td class="number">3</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code> </code><code>(A) contains identical amounts of the same active </code></td></tr><tr><td class="number">4</td><td class="junk"></td><td class="xsl" > <code>drug ingredient in the same dosage form and route of </code></td></tr><tr><td class="number">5</td><td class="junk"></td><td class="xsl" > <code>administration; and</code></td></tr><tr><td class="number">6</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code> </code><code>(B) meets compendial or other applicable standards </code></td></tr><tr><td class="number">7</td><td class="junk"></td><td class="xsl" > <code>of strength, quality, purity, and identity;</code></td></tr><tr><td class="number">8</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(3) it is bioequivalent in that:</code></td></tr><tr><td class="number">9</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code> </code><code>(A) it does not present a known or potential </code></td></tr><tr><td class="number">10</td><td class="junk"></td><td class="xsl" > <code>bioequivalence problem and it meets an acceptable in </code></td></tr><tr><td class="number">11</td><td class="junk"></td><td class="xsl" > <code>vitro standard; or</code></td></tr><tr><td class="number">12</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code> </code><code>(B) if it does present such a known or potential </code></td></tr><tr><td class="number">13</td><td class="junk"></td><td class="xsl" > <code>problem, it is shown to meet an appropriate </code></td></tr><tr><td class="number">14</td><td class="junk"></td><td class="xsl" > <code>bioequivalence standard;</code></td></tr><tr><td class="number">15</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(4) it is adequately labeled; and</code></td></tr><tr><td class="number">16</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(5) it is manufactured in compliance with Current Good </code></td></tr><tr><td class="number">17</td><td class="junk"></td><td class="xsl" > <code>Manufacturing Practice regulations adopted by the United </code></td></tr><tr><td class="number">18</td><td class="junk"></td><td class="xsl" > <code>States Food and Drug Administration.</code></td></tr><tr><td class="number">19</td><td class="junk"></td><td class="xsl" ><code> </code><code>(b) An individual or group policy of accident and health </code></td></tr><tr><td class="number">20</td><td class="junk"></td><td class="xsl" ><code>insurance amended, delivered, issued, or renewed in this State </code></td></tr><tr><td class="number">21</td><td class="junk"></td><td class="xsl" ><code>on or after January 1, 2024 shall provide coverage for all </code></td></tr><tr><td class="number">22</td><td class="junk"></td><td class="xsl" ><code>abortifacients, hormonal therapy medication, human </code></td></tr><tr><td class="number">23</td><td class="junk"></td><td class="xsl" ><code>immunodeficiency virus pre-exposure prophylaxis, and </code></td></tr><tr><td class="number">24</td><td class="junk"></td><td class="xsl" ><code>post-exposure prophylaxis drugs approved by the United States </code></td></tr><tr><td class="number">25</td><td class="junk"></td><td class="xsl" ><code>Food and Drug Administration, and follow-up services related </code></td></tr><tr><td class="number">26</td><td class="junk"></td><td class="xsl" ><code>to that coverage, including, but not limited to, management of </code></td></tr></table><table class="xsl" width="650"><tr><td class="lineNum" colspan="3"><p> </p><p> </p></td></tr><tr><td class="xsl" colspan="3"><table class="xsl" width="100%"><colgroup width="5%"></colgroup><colgroup width="5%"></colgroup><colgroup width="30%"></colgroup><colgroup width="20%"></colgroup><colgroup width="40%"></colgroup><tr><td class="number"></td><td class="junk"></td><td class="xsl" align="left">HB2584 Engrossed</td><td class="xsl" align="center">- 3 -</td><td class="xsl" align="right">LRB104 08321 BAB 18372 b</td></tr></table></td></tr><tr><td class="xsl"> </td></tr><tr><td class="number">1</td><td class="junk"></td><td class="xsl" ><code>side effects, medication self-management or adherence </code></td></tr><tr><td class="number">2</td><td class="junk"></td><td class="xsl" ><code>counseling, risk reduction strategies, and mental health </code></td></tr><tr><td class="number">3</td><td class="junk"></td><td class="xsl" ><code>counseling. This coverage shall include drugs approved by the </code></td></tr><tr><td class="number">4</td><td class="junk"></td><td class="xsl" ><code>United States Food and Drug Administration that are prescribed </code></td></tr><tr><td class="number">5</td><td class="junk"></td><td class="xsl" ><code>or ordered for off-label use for the purposes described in </code></td></tr><tr><td class="number">6</td><td class="junk"></td><td class="xsl" ><code>this Section. </code><u><code>On or after the effective date of this </code></u></td></tr><tr><td class="number">7</td><td class="junk"></td><td class="xsl" ><u><code>amendatory Act of the 104th General Assembly, this coverage </code></u></td></tr><tr><td class="number">8</td><td class="junk"></td><td class="xsl" ><u><code>shall include pre-PrEP HIV screening, sexually transmitted </code></u></td></tr><tr><td class="number">9</td><td class="junk"></td><td class="xsl" ><u><code>infection screening, kidney function analysis, routine </code></u></td></tr><tr><td class="number">10</td><td class="junk"></td><td class="xsl" ><u><code>laboratory testing, and routine provider visits.</code></u><code> </code></td></tr><tr><td class="number">11</td><td class="junk"></td><td class="xsl" ><code> </code><code>(c) The coverage required under subsection (b) is subject </code></td></tr><tr><td class="number">12</td><td class="junk"></td><td class="xsl" ><code>to the following conditions:</code></td></tr><tr><td class="number">13</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(1) If the United States Food and Drug Administration </code></td></tr><tr><td class="number">14</td><td class="junk"></td><td class="xsl" > <code>has approved one or more therapeutic equivalent versions </code></td></tr><tr><td class="number">15</td><td class="junk"></td><td class="xsl" > <code>of an abortifacient drug, a policy is not required to </code></td></tr><tr><td class="number">16</td><td class="junk"></td><td class="xsl" > <code>include all such therapeutic equivalent versions in its </code></td></tr><tr><td class="number">17</td><td class="junk"></td><td class="xsl" > <code>formulary so long as at least one is included and covered </code></td></tr><tr><td class="number">18</td><td class="junk"></td><td class="xsl" > <code>without cost sharing and in accordance with this Section.</code></td></tr><tr><td class="number">19</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(2) If an individual's attending provider recommends a </code></td></tr><tr><td class="number">20</td><td class="junk"></td><td class="xsl" > <code>particular drug approved by the United States Food and </code></td></tr><tr><td class="number">21</td><td class="junk"></td><td class="xsl" > <code>Drug Administration based on a determination of medical </code></td></tr><tr><td class="number">22</td><td class="junk"></td><td class="xsl" > <code>necessity with respect to that individual, the plan or </code></td></tr><tr><td class="number">23</td><td class="junk"></td><td class="xsl" > <code>issuer must defer to the determination of the attending </code></td></tr><tr><td class="number">24</td><td class="junk"></td><td class="xsl" > <code>provider and must cover that service or item without cost </code></td></tr><tr><td class="number">25</td><td class="junk"></td><td class="xsl" > <code>sharing.</code></td></tr><tr><td class="number">26</td><td class="junk"></td><td class="xsl" ><code> </code><code> </code><code>(3) If a drug is not covered, plans and issuers must </code></td></tr></table><table class="xsl" width="650"><tr><td class="lineNum" colspan="3"><p> </p><p> </p></td></tr><tr><td class="xsl" colspan="3"><table class="xsl" width="100%"><colgroup width="5%"></colgroup><colgroup width="5%"></colgroup><colgroup width="30%"></colgroup><colgroup width="20%"></colgroup><colgroup width="40%"></colgroup><tr><td class="number"></td><td class="junk"></td><td class="xsl" align="left">HB2584 Engrossed</td><td class="xsl" align="center">- 4 -</td><td class="xsl" align="right">LRB104 08321 BAB 18372 b</td></tr></table></td></tr><tr><td class="xsl"> </td></tr><tr><td class="number">1</td><td class="junk"></td><td class="xsl" > <code>have an easily accessible, transparent, and sufficiently </code></td></tr><tr><td class="number">2</td><td class="junk"></td><td class="xsl" > <code>expedient process that is not unduly burdensome on the </code></td></tr><tr><td class="number">3</td><td class="junk"></td><td class="xsl" > <code>individual or a provider or other individual acting as a </code></td></tr><tr><td class="number">4</td><td class="junk"></td><td class="xsl" > <code>patient's authorized representative to ensure coverage </code></td></tr><tr><td class="number">5</td><td class="junk"></td><td class="xsl" > <code>without cost sharing.</code></td></tr><tr><td class="number">6</td><td class="junk"></td><td class="xsl" ><code> </code><code>The conditions listed under this subsection (c) also apply </code></td></tr><tr><td class="number">7</td><td class="junk"></td><td class="xsl" ><code>to drugs prescribed for off-label use as abortifacients. </code></td></tr><tr><td class="number">8</td><td class="junk"></td><td class="xsl" ><code> </code><code>(d) Except as otherwise provided in this Section, a policy </code></td></tr><tr><td class="number">9</td><td class="junk"></td><td class="xsl" ><code>subject to this Section shall not impose a deductible, </code></td></tr><tr><td class="number">10</td><td class="junk"></td><td class="xsl" ><code>coinsurance, copayment, or any other cost-sharing requirement </code></td></tr><tr><td class="number">11</td><td class="junk"></td><td class="xsl" ><code>on the coverage provided. The provisions of this subsection do </code></td></tr><tr><td class="number">12</td><td class="junk"></td><td class="xsl" ><code>not apply to coverage of procedures to the extent such </code></td></tr><tr><td class="number">13</td><td class="junk"></td><td class="xsl" ><code>coverage would disqualify a high-deductible health plan from </code></td></tr><tr><td class="number">14</td><td class="junk"></td><td class="xsl" ><code>eligibility for a health savings account pursuant to the </code></td></tr><tr><td class="number">15</td><td class="junk"></td><td class="xsl" ><code>federal Internal Revenue Code, 26 U.S.C. 223.</code></td></tr><tr><td class="number">16</td><td class="junk"></td><td class="xsl" ><code> </code><code>(e) Except as otherwise authorized under this Section, a </code></td></tr><tr><td class="number">17</td><td class="junk"></td><td class="xsl" ><code>policy shall not impose any restrictions or delays on the </code></td></tr><tr><td class="number">18</td><td class="junk"></td><td class="xsl" ><code>coverage required under this Section.</code></td></tr><tr><td class="number">19</td><td class="junk"></td><td class="xsl" ><code> </code><code>(f) The coverage requirements in this Section for </code></td></tr><tr><td class="number">20</td><td class="junk"></td><td class="xsl" ><code>abortifacients do not, pursuant to 42 U.S.C. 18054(a)(6), </code></td></tr><tr><td class="number">21</td><td class="junk"></td><td class="xsl" ><code>apply to a multistate plan that does not provide coverage for </code></td></tr><tr><td class="number">22</td><td class="junk"></td><td class="xsl" ><code>abortion.</code></td></tr><tr><td class="number">23</td><td class="junk"></td><td class="xsl" ><code> </code><code>(g) If the Department concludes that enforcement of any </code></td></tr><tr><td class="number">24</td><td class="junk"></td><td class="xsl" ><code>coverage requirement of this Section for abortifacients may </code></td></tr><tr><td class="number">25</td><td class="junk"></td><td class="xsl" ><code>adversely affect the allocation of federal funds to this </code></td></tr><tr><td class="number">26</td><td class="junk"></td><td class="xsl" ><code>State, the Department may grant an exemption to that </code></td></tr></table><table class="xsl" width="650"><tr><td class="lineNum" colspan="3"><p> </p><p> </p></td></tr><tr><td class="xsl" colspan="3"><table class="xsl" width="100%"><colgroup width="5%"></colgroup><colgroup width="5%"></colgroup><colgroup width="30%"></colgroup><colgroup width="20%"></colgroup><colgroup width="40%"></colgroup><tr><td class="number"></td><td class="junk"></td><td class="xsl" align="left">HB2584 Engrossed</td><td class="xsl" align="center">- 5 -</td><td class="xsl" align="right">LRB104 08321 BAB 18372 b</td></tr></table></td></tr><tr><td class="xsl"> </td></tr><tr><td class="number">1</td><td class="junk"></td><td class="xsl" ><code>requirement, but only to the minimum extent necessary to </code></td></tr><tr><td class="number">2</td><td class="junk"></td><td class="xsl" ><code>ensure the continued receipt of federal funds.</code></td></tr><tr><td class="number">3</td><td class="junk"></td><td class="xsl" ><code>(Source: P.A. 102-1117, eff. 1-13-23; 103-462, eff. 8-4-23.)</code> </td></tr><tr><td class="number">4</td><td class="junk"></td><td class="xsl" ><code> </code><code>Section 10. </code><code>The Prior Authorization Reform Act is amended </code></td></tr><tr><td class="number">5</td><td class="junk"></td><td class="xsl" ><code>by adding Section 52 as follows:</code> </td></tr><tr><td class="number">6</td><td class="junk"></td><td class="xsl" ><code> </code><code>(215 ILCS 200/52 new)</code></td></tr><tr><td class="number">7</td><td class="junk"></td><td class="xsl" ><code> </code><u><code>Sec. 52. </code></u><u><code>Prior authorization for certain prescription </code></u></td></tr><tr><td class="number">8</td><td class="junk"></td><td class="xsl" ><u><code>drugs; prohibited. </code></u><u><code>A health insurance issuer may not require </code></u></td></tr><tr><td class="number">9</td><td class="junk"></td><td class="xsl" ><u><code>prior authorization for the following prescription drug types </code></u></td></tr><tr><td class="number">10</td><td class="junk"></td><td class="xsl" ><u><code>and their therapeutic equivalents approved by the United </code></u></td></tr><tr><td class="number">11</td><td class="junk"></td><td class="xsl" ><u><code>States Food and Drug Administration: human immunodeficiency </code></u></td></tr><tr><td class="number">12</td><td class="junk"></td><td class="xsl" ><u><code>virus pre-exposure prophylaxis and post-exposure prophylaxis </code></u></td></tr><tr><td class="number">13</td><td class="junk"></td><td class="xsl" ><u><code>medication or human immunodeficiency virus treatment </code></u></td></tr><tr><td class="number">14</td><td class="junk"></td><td class="xsl" ><u><code>medication.</code></u> </td></tr><tr><td class="number">15</td><td class="junk"></td><td class="xsl" ><code> </code><code>Section 99. </code><code>Effective date. </code><code>This Act takes effect January </code></td></tr><tr><td class="number">16</td><td class="junk"></td><td class="xsl" ><code>1, 2027.</code>