IL SB0275

Requires health insurance carriers offering prescription drug coverage to ensure at least 50% of individual and group plans in each service area meet one or more of three criteria beginning January 1, 2022.

Plans must either: (1) apply pre-deductible flat-dollar copayments with graduated, proportionate tier structures; (2) cap monthly out-of-pocket costs at $150 per 30-day supply per drug; or (3) cap annual out-of-pocket costs at the minimum amounts set under Internal Revenue Code Section 223(c)(2)(A)(i) for self-only coverage.

Qualifying plans must be clearly named to aid consumer selection, marketed the same as other carrier plans, and offered to both individual and group plan sponsors.

The Department of Insurance shall adopt rules to implement and enforce the requirements.

Act becomes effective January 1, 2022.