The intended impact of HB5865 is to ensure that consumers benefit directly from rebate amounts received by insurers, translating to lower out-of-pocket costs at the point of sale. Furthermore, any rebates that exceed the cost-sharing amount must go towards reducing overall premiums for the health plan, potentially contributing to wider healthcare affordability and access. The implementation of this measure could necessitate changes in how insurance companies structure their pricing and rebate strategies.
Summary
HB5865 amends the Illinois Insurance Code to change the way that cost sharing for prescription drugs is calculated for health insurance policies. Starting January 1, 2025, it mandates that any group or individual policy covering prescription drugs must calculate a covered individual's defined cost sharing at the point of sale, using a price that factors in any rebates received in connection with that drug. This means that the cost sharing amount will be reduced by at least 100% of all rebates, effectively lowering the price the patient pays at the pharmacy counter.
Contention
While the bill generally aims to improve patient financial outcomes, there may be contention surrounding its implementation. Concerns could arise from insurance providers regarding the financial implications of adjusting their rebate practices and the potential administrative burden of calculating cost sharing at the point of sale. Additionally, discussions may focus on how this change could affect negotiated rates with pharmaceutical companies and how it may lead to further price restructuring in the prescription drug market.
Relating to the regulation of prescriptions for controlled substances, including certain procedures applicable to electronic prescriptions for Schedule II controlled substances.