IL SB3225

Requires health benefit plans amended, delivered, issued, or renewed on or after January 1, 2025 to prohibit certain restrictions on clinician-administered drugs, including requirements to use plan-selected pharmacies or incentives to steer patients to specific pharmacies.

Prohibits health benefit plans from conditioning coverage, denying benefits, or imposing higher cost-sharing for clinician-administered drugs obtained from non-plan-selected providers or pharmacies.

Prohibits health benefit plans from requiring enrollees to use home infusion pharmacies or including site of service in prior approval or medical necessity criteria for clinician-administered drugs.

Defines "clinician-administered drug" as outpatient prescription drugs (excluding vaccines) that cannot be self-administered and are typically administered by authorized health care providers in clinical settings like physician offices or infusion centers.

Applies requirements to health benefit plans under the State Employees Group Insurance Act, Counties Code, Illinois Municipal Code, School Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act; Department of Insurance may adopt implementing rules.