IL HB3638

Enacts the Health Insurance Consumer Protection Act of 2014 to enhance consumer protections for health insurance policies offered through Illinois Health Insurance Marketplace, building on federal Patient Protection and Affordable Care Act requirements.

Requires qualified health plans to make prescription drug formularies, tiering information, provider directories, and cost-sharing details available to consumers at the time of plan comparison, with information accessible online and through alternative means for those without internet access.

Establishes medical exceptions procedures allowing covered persons to request clinically appropriate prescription drugs when drugs are not formulary-covered, formulary coverage is discontinued, step therapy fails, or dose restrictions are ineffective, with decisions required within 72 hours (or 24 hours for expedited requests).

Mandates health insurers providing prescription drug benefits must respond to prior authorization requests from prescribers or pharmacists within 72 hours (or 24 hours for expedited determinations), with denials requiring specified reasons and information about alternative medications and appeal procedures.

Applies all qualified health plan requirements to coverage years beginning January 1, 2015, and does not apply to Medicare or Medicaid beneficiary plans.