IL SB1359

Limits copayments or coinsurance for specialty tier prescription drugs to a maximum of $100 per month for up to a 30-day supply of any single drug, applicable at any point in the benefit design including before deductibles are met.

Caps annual out-of-pocket expenditures for prescription drugs at no more than 50% of the dollar amounts specified in Section 1302(c)(1) of the federal Affordable Care Act for self-only and family coverage.

Requires health plans using tiered formularies to implement an exceptions process allowing enrollees to request non-preferred drugs be covered at preferred drug cost-sharing rates if a prescribing provider determines preferred alternatives would be less effective or cause adverse effects.

Prohibits health plans from placing all drugs in a given class on a specialty tier.

Takes effect January 1, 2016, with the Director of Insurance responsible for adopting enforcement rules.