House Bill 4146 would ensure individuals receive the prescription drug coverage they rely on by limiting midyear drug formulary changes by insurers
July 2, 2018 – The Illinois Fair Care Coalition, a group of state-based and national patient and provider groups working to ensure that health benefits will be honored throughout the health plan year, today sent a letter to Illinois Governor Bruce Rauner, calling on him to sign House Bill 4146 into law and protect consumers with commercial health insurance coverage by ensuring that health plans deliver the policies they sell.
HB 4146 amends the Managed Care Reform and Patient Rights Act to prohibit insurers from making unfair midyear prescription drug coverage changes while Illinoisans are locked into their policy and receiving a prescription drug benefit. The bill passed out of the Illinois House and Senate with bipartisan support unanimously, and has been sent to the governor’s desk for signing. If signed, the law would take effect immediately.
“We urge you Mr. Governor…to support HB 4146 and make it the law in Illinois. In doing so, you’ll help protect families across our great state, said the Illinois Fair Care Coalition. “House Bill 4146 would provide critical improvements to the current system, building in safeguards to keep patients medically stable, while preserving ethical business practices.”
House Bill 4146 recognizes that when commercial health insurers increase out-of-pocket costs or deny benefit coverage during the policy year, consumers in Illinois currently have nowhere to turn for help. To address this problem, HB 4146 provides an easy-to-use appeals process for providers to receive exemptions for their patients from these unfair health plan changes, ensuring continuity of the medical care for the prescription drug benefits on which they rely. 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) deems it unsafe or if the FDA or the manufacturer withdraws the drug from the market.
The letter from the IL Fair Care Coalition discusses the case of Illinoisan Joanne Guthrie-Gard, whose story was recently profiled in the Chicago Tribune. Joanne’s daughter Erin suffers from epilepsy, sometimes experiencing as many as 20 seizures a week. It took Joanne and Erin years of searching and experimenting on medicines with dangerous side effects before they found one that controlled her symptoms. But four months in to that new regimen, Erin’s insurance plan suddenly stopped covering the medication. Erin was told to go back to a previous drug or pay tens of thousands of dollars out of pocket, which she simply could not afford. Erin switched back to the original ineffective drug, and the side effects returned, causing her to miss hours of school and putting her at risk of serious falls. Erin’s effective medication was eventually covered, but for 10 years, Joanne and Erin have lived with the worry that her medication could be changed once again.
If Illinois passes HB 4146, it would join California, Nevada, Louisiana and Texas in implementing policies to protect patients from coverage reductions during the plan year. Fifty-five million Americans who are covered through Medicare, including more than two million Illinoisans, are already protected from these midyear health benefit reductions.
About the Illinois Fair Care Coalition
The Illinois Fair Care Coalition is a group of the Prairie State’s leading patient and provider groups working to ensure that commercial health insurance coverage will be concrete over the course of each year.
Members include: AIDS Foundation of Chicago, Alliance for Patient Access, American Autoimmune Related Diseases Association, American Diabetes Association, Arthritis Foundation, Global Healthy Living Foundation, Illinois Psychiatric Society, International Pain Foundation, Illinois State Medical Society, Lupus and Allied Diseases Association, Mental Health America of Illinois, Mental Health Summit, National Infusion Center Association, Sick Cells, U.S. Pain Foundation.