Major health insurance changes to become law in Illinois

Gov. J.B. Pritzker said the Healthcare Protection Act (HPA) includes a package of measures designed to restrict methods that insurance companies use to reduce the amount of health care patients receive. 

“For thousands of Illinoisans, the reforms in this bill will mean the difference between suffering with curable health conditions and getting the care that they need in a timely manner, and for some, this bill will quite literally save their lives,” Pritzker said.

Among other things, the law bars the use of a restriction known as “step therapy” that requires a patient to try and fail on treatments preferred by the insurance company before they can access the treatment recommended by their doctor. 

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HPA also prohibits insurers from requiring prior authorization before a patient can receive emergency treatment at a psychiatric facility. 

“Illinois, by the way, is once again a pioneer, the first state in the nation to do this for adults and children,” said Pritzker.  

The HPA also ends unchecked rate increases for large group insurance companies. 

Senate President Don Harmon, D-Oak Park, said from now on in Illinois, the focus will be on the patient.

“Somewhere along the line, priorities got out of whack,” said Harmon. “Instead of helping patients find the best care for their individual needs, the focus too often shifted to maximizing profits.”

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Opponents of the legislation were concerned about how the law will affect insurance premiums. It has been estimated that it could cost state taxpayers an extra $30 million a year. 

When the bill was moving through the Illinois legislature, the Illinois Freedom Caucus released a statement.

“Only in Illinois can we pass a bill which raises insurance premiums for working families, delivers more free Cadillac healthcare for illegals, and call it a success,” the group said. 

Other laws going into effect include SB 2672, which requires any provider of a group or individual policy of accident and health insurance or a managed care plan to provide coverage for a brand name prescription drug, if a generic drug is unavailable due to a supply issue until the generic drug is available.

Another law prohibits hospitals from directly billing a patient that is 138% below the federal poverty line, and another measure limits the cost of epinephrine injectors to a maximum of $60 per twin-pack.