Illinois 2025-2026 Regular Session

Illinois Senate Bill SB2152 Compare Versions

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

Old	New	Differences
1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2152 Introduced 2/7/2025, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.11215 ILCS 200/10215 ILCS 200/50215 ILCS 200/65 Amends the Prior Authorization Reform Act. Provides that the Act applies to policies issued or delivered to persons who are enrolled in the State Employee Group Health Insurance Program to the extent required under a provision of the State Employees Group Insurance Act of 1971 concerning required health benefits. Provides that a health insurance issuer shall not require prior authorization where a covered medication, with the exception of benzodiazepines or Schedule II narcotic drugs: (1) is prescribed for the management and treatment of multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes type 1, diabetes type 2, or pre-diabetes; and (2) is for a patient currently managed with an established treatment regimen for at least 12 months. Provides that nothing in the provision prevents a health care plan from denying an enrollee coverage or imposing a prior authorization requirement if the United States Food and Drug Administration has issued a statement about the drug that calls into question the clinical safety of the drug, the drug manufacturer has notified the United States Food and Drug Administration of a manufacturing discontinuance or potential discontinuance of the drug, or the drug manufacturer has removed the drug from the market. In a provision concerning the length of prior authorization approval for treatment of chronic or long-term condition, excludes a provision of the State Employees Group Insurance Act of 1971 concerning coverage for injectable medicines to improve glucose or weight loss. Effective January 1, 2027. LRB104 11051 BAB 21133 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2152 Introduced 2/7/2025, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.11215 ILCS 200/10215 ILCS 200/50215 ILCS 200/65 5 ILCS 375/6.11 215 ILCS 200/10 215 ILCS 200/50 215 ILCS 200/65 Amends the Prior Authorization Reform Act. Provides that the Act applies to policies issued or delivered to persons who are enrolled in the State Employee Group Health Insurance Program to the extent required under a provision of the State Employees Group Insurance Act of 1971 concerning required health benefits. Provides that a health insurance issuer shall not require prior authorization where a covered medication, with the exception of benzodiazepines or Schedule II narcotic drugs: (1) is prescribed for the management and treatment of multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes type 1, diabetes type 2, or pre-diabetes; and (2) is for a patient currently managed with an established treatment regimen for at least 12 months. Provides that nothing in the provision prevents a health care plan from denying an enrollee coverage or imposing a prior authorization requirement if the United States Food and Drug Administration has issued a statement about the drug that calls into question the clinical safety of the drug, the drug manufacturer has notified the United States Food and Drug Administration of a manufacturing discontinuance or potential discontinuance of the drug, or the drug manufacturer has removed the drug from the market. In a provision concerning the length of prior authorization approval for treatment of chronic or long-term condition, excludes a provision of the State Employees Group Insurance Act of 1971 concerning coverage for injectable medicines to improve glucose or weight loss. Effective January 1, 2027. LRB104 11051 BAB 21133 b LRB104 11051 BAB 21133 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2152 Introduced 2/7/2025, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
3	3	5 ILCS 375/6.11215 ILCS 200/10215 ILCS 200/50215 ILCS 200/65 5 ILCS 375/6.11 215 ILCS 200/10 215 ILCS 200/50 215 ILCS 200/65
4	4	5 ILCS 375/6.11
5	5	215 ILCS 200/10
6	6	215 ILCS 200/50
7	7	215 ILCS 200/65
8	8	Amends the Prior Authorization Reform Act. Provides that the Act applies to policies issued or delivered to persons who are enrolled in the State Employee Group Health Insurance Program to the extent required under a provision of the State Employees Group Insurance Act of 1971 concerning required health benefits. Provides that a health insurance issuer shall not require prior authorization where a covered medication, with the exception of benzodiazepines or Schedule II narcotic drugs: (1) is prescribed for the management and treatment of multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes type 1, diabetes type 2, or pre-diabetes; and (2) is for a patient currently managed with an established treatment regimen for at least 12 months. Provides that nothing in the provision prevents a health care plan from denying an enrollee coverage or imposing a prior authorization requirement if the United States Food and Drug Administration has issued a statement about the drug that calls into question the clinical safety of the drug, the drug manufacturer has notified the United States Food and Drug Administration of a manufacturing discontinuance or potential discontinuance of the drug, or the drug manufacturer has removed the drug from the market. In a provision concerning the length of prior authorization approval for treatment of chronic or long-term condition, excludes a provision of the State Employees Group Insurance Act of 1971 concerning coverage for injectable medicines to improve glucose or weight loss. Effective January 1, 2027.
9	9	LRB104 11051 BAB 21133 b LRB104 11051 BAB 21133 b
10	10	LRB104 11051 BAB 21133 b
11	11	A BILL FOR
12	12	SB2152LRB104 11051 BAB 21133 b SB2152 LRB104 11051 BAB 21133 b
13	13	SB2152 LRB104 11051 BAB 21133 b
14	14	1 AN ACT concerning regulation.
15	15	2 Be it enacted by the People of the State of Illinois,
16	16	3 represented in the General Assembly:
17	17	4 Section 5. The State Employees Group Insurance Act of 1971
18	18	5 is amended by changing Section 6.11 as follows:
19	19	6 (5 ILCS 375/6.11)
20	20	7 Sec. 6.11. Required health benefits; Illinois Insurance
21	21	8 Code requirements. The program of health benefits shall
22	22	9 provide the post-mastectomy care benefits required to be
23	23	10 covered by a policy of accident and health insurance under
24	24	11 Section 356t of the Illinois Insurance Code. The program of
25	25	12 health benefits shall provide the coverage required under
26	26	13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
27	27	14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
28	28	15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
29	29	16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
30	30	17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
31	31	18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
32	32	19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
33	33	20 356z.70, and 356z.71, 356z.74, 356z.76, and 356z.77 of the
34	34	21 Illinois Insurance Code. The program of health benefits must
35	35	22 comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
36	36	23 370c.1 and Article XXXIIB of the Illinois Insurance Code, and
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40	40	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2152 Introduced 2/7/2025, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
41	41	5 ILCS 375/6.11215 ILCS 200/10215 ILCS 200/50215 ILCS 200/65 5 ILCS 375/6.11 215 ILCS 200/10 215 ILCS 200/50 215 ILCS 200/65
42	42	5 ILCS 375/6.11
43	43	215 ILCS 200/10
44	44	215 ILCS 200/50
45	45	215 ILCS 200/65
46	46	Amends the Prior Authorization Reform Act. Provides that the Act applies to policies issued or delivered to persons who are enrolled in the State Employee Group Health Insurance Program to the extent required under a provision of the State Employees Group Insurance Act of 1971 concerning required health benefits. Provides that a health insurance issuer shall not require prior authorization where a covered medication, with the exception of benzodiazepines or Schedule II narcotic drugs: (1) is prescribed for the management and treatment of multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes type 1, diabetes type 2, or pre-diabetes; and (2) is for a patient currently managed with an established treatment regimen for at least 12 months. Provides that nothing in the provision prevents a health care plan from denying an enrollee coverage or imposing a prior authorization requirement if the United States Food and Drug Administration has issued a statement about the drug that calls into question the clinical safety of the drug, the drug manufacturer has notified the United States Food and Drug Administration of a manufacturing discontinuance or potential discontinuance of the drug, or the drug manufacturer has removed the drug from the market. In a provision concerning the length of prior authorization approval for treatment of chronic or long-term condition, excludes a provision of the State Employees Group Insurance Act of 1971 concerning coverage for injectable medicines to improve glucose or weight loss. Effective January 1, 2027.
47	47	LRB104 11051 BAB 21133 b LRB104 11051 BAB 21133 b
48	48	LRB104 11051 BAB 21133 b
49	49	A BILL FOR
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55	55	5 ILCS 375/6.11
56	56	215 ILCS 200/10
57	57	215 ILCS 200/50
58	58	215 ILCS 200/65
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62	62	LRB104 11051 BAB 21133 b
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76	76	SB2152 - 2 - LRB104 11051 BAB 21133 b
77	77	1 the Prior Authorization Reform Act. The program of health
78	78	2 benefits shall provide the coverage required under Section
79	79	3 356m of the Illinois Insurance Code and, for the employees of
80	80	4 the State Employee Group Insurance Program only, the coverage
81	81	5 as also provided in Section 6.11B of this Act. The Department
82	82	6 of Insurance shall enforce the requirements of this Section
83	83	7 with respect to Sections 370c and 370c.1 of the Illinois
84	84	8 Insurance Code and the Prior Authorization Reform Act; all
85	85	9 other requirements of this Section shall be enforced by the
86	86	10 Department of Central Management Services.
87	87	11 Rulemaking authority to implement Public Act 95-1045, if
88	88	12 any, is conditioned on the rules being adopted in accordance
89	89	13 with all provisions of the Illinois Administrative Procedure
90	90	14 Act and all rules and procedures of the Joint Committee on
91	91	15 Administrative Rules; any purported rule not so adopted, for
92	92	16 whatever reason, is unauthorized.
93	93	17 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
94	94	18 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
95	95	19 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
96	96	20 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
97	97	21 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
98	98	22 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
99	99	23 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
100	100	24 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
101	101	25 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
102	102	26 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
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108	108	SB2152 - 2 - LRB104 11051 BAB 21133 b
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111	111	SB2152- 3 -LRB104 11051 BAB 21133 b SB2152 - 3 - LRB104 11051 BAB 21133 b
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113	113	1 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
114	114	2 1-1-25; revised 11-26-24.)
115	115	3 Section 10. The Prior Authorization Reform Act is amended
116	116	4 by changing Sections 10, 50, and 65 as follows:
117	117	5 (215 ILCS 200/10)
118	118	6 Sec. 10. Applicability; scope. This Act applies to health
119	119	7 insurance coverage as defined in the Illinois Health Insurance
120	120	8 Portability and Accountability Act, policies issued or
121	121	9 delivered to persons who are enrolled in the State Employees
122	122	10 Group Health Insurance Program to the extent required under
123	123	11 Section 6.11 of the State Employees Group Insurance Act of
124	124	12 1971, and policies issued or delivered in this State to the
125	125	13 Department of Healthcare and Family Services and providing
126	126	14 coverage to persons who are enrolled under Article V of the
127	127	15 Illinois Public Aid Code or under the Children's Health
128	128	16 Insurance Program Act, amended, delivered, issued, or renewed
129	129	17 on or after the effective date of this Act, with the exception
130	130	18 of employee or employer self-insured health benefit plans
131	131	19 under the federal Employee Retirement Income Security Act of
132	132	20 1974, health care provided pursuant to the Workers'
133	133	21 Compensation Act or the Workers' Occupational Diseases Act,
134	134	22 county, municipal, and State, employee, unit of local
135	135	23 government, or school district health plans. This Act does not
136	136	24 diminish a health care plan's duties and responsibilities
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142	142	SB2152 - 3 - LRB104 11051 BAB 21133 b
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147	147	1 under other federal or State law or rules promulgated
148	148	2 thereunder. This Act is not intended to alter or impede the
149	149	3 provisions of any consent decree or judicial order to which
150	150	4 the State or any of its agencies is a party.
151	151	5 (Source: P.A. 102-409, eff. 1-1-22.)
152	152	6 (215 ILCS 200/50)
153	153	7 Sec. 50. Limitations on Review of prior authorization
154	154	8 requirements.
155	155	9 (a) A health insurance issuer shall not require
156	156	10 periodically review its prior authorization requirements and
157	157	11 consider removal of prior authorization where a covered
158	158	12 medication, with the exception of benzodiazepines or Schedule
159	159	13 II narcotic drugs requirements:
160	160	14 (1) is where a medication or procedure prescribed for
161	161	15 the management and treatment of multiple sclerosis,
162	162	16 rheumatoid arthritis, systemic lupus erythematosus,
163	163	17 diabetes type 1, diabetes type 2, or pre-diabetes is
164	164	18 customary and properly indicated or is a treatment for the
165	165	19 clinical indication as supported by peer-reviewed medical
166	166	20 publications; and or
167	167	21 (2) is for a patient patients currently managed with
168	168	22 an established treatment regimen for at least 12 months.
169	169	23 (b) Nothing in this Section prevents a health care plan
170	170	24 from denying an enrollee coverage or imposing a prior
171	171	25 authorization requirement if the United States Food and Drug
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177	177	SB2152 - 4 - LRB104 11051 BAB 21133 b
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182	182	1 Administration has issued a statement about the drug that
183	183	2 calls into question the clinical safety of the drug, the drug
184	184	3 manufacturer has notified the United States Food and Drug
185	185	4 Administration of a manufacturing discontinuance or potential
186	186	5 discontinuance of the drug as required by Section 506C of the
187	187	6 Federal Food, Drug, and Cosmetic Act, as codified in 21 U.S.C.
188	188	7 356c, or the drug manufacturer has removed the drug from the
189	189	8 market.
190	190	9 (c) Except to the extent required by medical exceptions
191	191	10 processes for prescription drugs set forth in Section 45.1 of
192	192	11 the Managed Care and Patient Rights Act, nothing in this
193	193	12 Section shall require a policy to cover any care, treatment,
194	194	13 or services for any health condition that the terms of
195	195	14 coverage otherwise completely exclude from the policy's
196	196	15 covered benefits without regard for whether the care,
197	197	16 treatment, or services are medically necessary.
198	198	17 (Source: P.A. 102-409, eff. 1-1-22.)
199	199	18 (215 ILCS 200/65)
200	200	19 Sec. 65. Length of prior authorization approval for
201	201	20 treatment for chronic or long-term conditions. If a health
202	202	21 insurance issuer requires a prior authorization for a
203	203	22 recurring health care service or maintenance medication for
204	204	23 the treatment of a chronic or long-term condition other than
205	205	24 those specified in Section 50, the approval shall remain valid
206	206	25 for the lesser of 12 months from the date the health care
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217	217	1 professional or health care provider receives the prior
218	218	2 authorization approval or the length of the treatment as
219	219	3 determined by the patient's health care professional. This
220	220	4 Section shall not apply to the prescription of benzodiazepines
221	221	5 or Schedule II narcotic drugs, such as opioids. This Section
222	222	6 does not apply to Section 6.11C of the State Employees Group
223	223	7 Insurance Act of 1971. Except to the extent required by
224	224	8 medical exceptions processes for prescription drugs set forth
225	225	9 in Section 45.1 of the Managed Care Reform and Patient Rights
226	226	10 Act, nothing in this Section shall require a policy to cover
227	227	11 any care, treatment, or services for any health condition that
228	228	12 the terms of coverage otherwise completely exclude from the
229	229	13 policy's covered benefits without regard for whether the care,
230	230	14 treatment, or services are medically necessary.
231	231	15 (Source: P.A. 102-409, eff. 1-1-22.)
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237	237	SB2152 - 6 - LRB104 11051 BAB 21133 b