SB3924 Summary

• Creates new Section 356z.26a of the Illinois Insurance Code effective January 1, 2023, establishing requirements for clinician-administered drugs covered by health benefit plans and pharmacy benefit managers.

• Prohibits health benefit plans from requiring enrollees to obtain clinician-administered drugs from plan-selected pharmacies, steering enrollees to specific pharmacies, requiring home infusion pharmacies, or including site of service in prior approval criteria.

• Prohibits plans from conditioning, denying, or limiting benefits based on whether drugs are obtained from non-plan-selected providers or pharmacies, and prohibits higher cost-sharing for non-plan providers.

• Requires clinician-administered drugs to comply with federal Drug Supply Chain Security Act standards for supply chain security and chain of distribution.

• Applies requirements to state employee health plans, county self-insured plans, municipal self-insured plans, school district plans, health maintenance organizations, and voluntary health services plans.