HB 1565

Abstract

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2024 and that provides coverage for prescription drugs shall provide coverage for vaginal estrogen, and that coverage for vaginal estrogen shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. House Floor Amendment No. 2 Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 (rather than January 1, 2024) and that provides coverage for prescription drugs shall include coverage for one or more therapeutic equivalent versions of vaginal estrogen in its formulary. Senate Committee Amendment No. 1 Provides that if (rather than if an individual's attending provider recommends) a particular vaginal estrogen product or its therapeutic equivalent version approved by the United States Food and Drug Administration is determined to be medically necessary (rather than based on the provider's determination), the issuer must cover that service or item pursuant to the cost-sharing requirement in specified provisions (rather than without cost sharing). Provides that a policy subject to the provisions shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement that exceeds any deductible, coinsurance, copayment, or any other cost-sharing requirement imposed on any prescription drug authorized for the treatment of erectile dysfunction covered by the policy (rather than on the coverage provided). Removes language providing that a policy is not required to include all therapeutic equivalent versions of vaginal estrogen in its formulary so long as at least one is included and covered without cost sharing and in accordance with the provisions.