Bill Text: IL SB3498 | 2017-2018 | 100th General Assembly | Introduced

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Bill Title: Amends the Managed Care Reform and Patient Rights Act. Requires a policy or plan sponsor to notify the prescribing physician and the patient in writing 60 days before making a formulary change that alters the terms of coverage or discontinues coverage for a prescribed drug that the patient is receiving. Contains provisions for receiving the notice electronically. Provides that a policy or plan sponsor may provide the patient with the written notification, along with a 60-day supply of the prescription drug, at the time the patient requests a refill. Provides that nothing in the provisions prohibits insurers or pharmacy benefit managers from using certain managed pharmacy care tools so long as an exception process is in place allowing the prescriber to petition for coverage a non-preferred drug if sufficient clinical reasons justify an exception to the normal protocol.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2019-01-09 - Session Sine Die [SB3498 Detail]

Download: Illinois-2017-SB3498-Introduced.html

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100TH GENERAL ASSEMBLY State of Illinois 2017 and 2018 SB3498 Introduced 2/16/2018, by Sen. Elgie R. Sims, Jr. SYNOPSIS AS INTRODUCED:
215 ILCS 134/45.3 new
Amends the Managed Care Reform and Patient Rights Act. Requires a policy or plan sponsor to notify the prescribing physician and the patient in writing 60 days before making a formulary change that alters the terms of coverage or discontinues coverage for a prescribed drug that the patient is receiving. Contains provisions for receiving the notice electronically. Provides that a policy or plan sponsor may provide the patient with the written notification, along with a 60-day supply of the prescription drug, at the time the patient requests a refill. Provides that nothing in the provisions prohibits insurers or pharmacy benefit managers from using certain managed pharmacy care tools so long as an exception process is in place allowing the prescriber to petition for coverage a non-preferred drug if sufficient clinical reasons justify an exception to the normal protocol.
LRB100 20562 SMS 35966 b
A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Managed Care Reform and Patient Rights Act
is amended by adding Section 45.3 as follows:
(215 ILCS 134/45.3 new)
Sec. 45.3. Provision of notice; formulary changes.
(a) At least 60 days before making a formulary change that
alters the terms of coverage or discontinues coverage for a
prescribed drug that a patient is receiving, a policy or plan
sponsor must, to the extent possible, notify the prescribing
physician and the patient, or the parent or guardian if the
patient is a child, or the spouse of a patient who is
authorized to consent to the treatment of the patient. The
notification shall be in writing and shall disclose the
formulary change, indicate that the prescribing physician may
initiate an appeal, and include information regarding the
procedure for the prescribing physician to initiate the policy
or plan sponsor's appeal process.
(b) As an alternative to providing written notice, a policy
or plan sponsor may provide the notice electronically if, and
only if, the patient affirmatively elects to receive the notice
electronically. The notification shall disclose the formulary

SB3498 - 2 - LRB100 20562 SMS 35966 b
change, indicate that the prescribing physician may initiate an
appeal, and include information regarding the procedure for the
prescribing physician to initiate the policy or plan sponsor's
appeal process.
(c) At the time a patient requests a refill of the
prescription drug, a policy or plan sponsor may provide the
patient with the written notification required under
subsection (a) along with a 60-day supply of the prescription
drug under the same terms as previously allowed.
(d) Nothing in this Section shall prohibit insurers or
pharmacy benefit managers from using managed pharmacy care
tools, including, but not limited to, formulary tiers, generic
substitution, therapeutic interchange, prior authorization, or
step therapy, so long as an exception process is in place
allowing the prescriber to petition for coverage of a
non-preferred drug if sufficient clinical reasons justify an
exception to the normal protocol.