IL HB3549

Adds Section 364 to the list of Illinois Insurance Code provisions that Health Maintenance Organizations must comply with.

Expands medical exceptions procedures to apply to all insurers licensed in Illinois selling group or individual accident and health insurance or health benefits plans, not just those offering qualified health plans under the Affordable Care Act.

Requires insurers to approve or deny prescription drug exception requests within 72 hours (or 24 hours for expedited requests) and provide reasons for denial with alternative medication options and appeal information.

Establishes three specific grounds for automatic approval of step therapy exception requests: when the required drug is contraindicated, the patient has previously failed or been intolerant to the required drug, or the patient is stable on a current prescription drug.

Mandates that approved exceptions must be honored for 12 months following approval or until plan renewal, and exempts the state medical assistance program from these requirements.