By Illinois Radio Network
SPRINGFIELD – A bill that would keep insurance providers from adding or removing a drug from a customer’s coverage plan mid-year is now on Governor Bruce Rauner’s desk.
If signed into law, the bill would keep an insurance provider from changing an enrollee’s coverage of a drug during the plan year if the drug was previously approved for coverage in certain situations.
Should the insurance company remove a drug, the bill would create an appeals process for providers to receive exemptions for their patients from plan changes, something supporters say ensures continuity of the medical care for the prescription drug benefits.
California, Nevada, Louisiana and Texas have similar laws.
Advocate JoAnne Guthrie-Gard said her 26-year-old daughter, Erin, needed a specific epilepsy medication. When her provider removed her daughter’s medication from their coverage plan, the cost skyrocketed.
“I was paying $120 per medication for three months of inventory as opposed to $40 for three months,” she said.
Her daughter was left with few options since they were not able to change plans until open enrollment.
“It would be a different story if you found out they were not going to cover it in June that, as of January first, the plan would no longer cover it,” she said. “They gave me five weeks.”
Opponents have said the bill would allow a drug’s price to skyrocket with little recourse for insurance companies once it’s accepted into a coverage plan.
“It allows a pharmaceutical manufacturer to increase its price over and over again within a year with no consequence,” said pharmacist Abigail Stoddard with Prime Therapeutics.
The plan would affect a small portion, about 17 percent, of Illinois’ healthcare market, not including Medicaid enrollees.
The legislation would still allow insurers to add new drugs to a formulary and remove a drug from a formulary if the Food and Drug Administration (FDA) deemed it unsafe or if the FDA or the manufacturer withdraws the drug from the market.
Rauner has 60 days from last Friday to act on the measure.
