Summary as Introduced
Amends the Illinois Insurance Code. Sets forth provisions requiring an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after January 1, 2028 to provide coverage for up to a 12-month supply of prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within the provider's scope of practice and dispensed at one time for an enrollee by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides that, notwithstanding any other provision of law, a dispensing provider or pharmacist shall dispense, at a patient's request, up to a 12-month supply of a prescription hormone therapy and the necessary supplies for self-administration pursuant to a valid prescription that specifies an initial quantity followed by periodic refills, except as specified. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code to require coverage under the provisions of those Acts.
Staff Analysis
Bill as Introduced
Amends the Illinois Insurance Code. Sets forth provisions requiring an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after January 1, 2028 to provide coverage for up to a 12-month supply of prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within the provider's scope of practice and dispensed at one time for an enrollee by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides that, notwithstanding any other provision of law, a dispensing provider or pharmacist shall dispense, at a patient's request, up to a 12-month supply of a prescription hormone therapy and the necessary supplies for self-administration pursuant to a valid prescription that specifies an initial quantity followed by periodic refills, except as specified. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code to require coverage under the provisions of those Acts.
Senate Committee Amendment 1
The amendment would require individual and group health insurance policies issued or renewed in Illinois on or after January 1, 2028 to provide coverage for up to a six-month supply of prescription hormone therapy and related self-administration supplies dispensed at one time. The amendment reduces the originally proposed coverage period from 12 months to six months and broadens prescribing authority by allowing prescriptions from any provider acting within the provider’s scope of practice rather than limiting prescriptions to network providers. The proposal also clarifies that if the hormone therapy is classified as a controlled substance, coverage would be limited to the maximum quantity permitted under State and federal law.
For counties, the legislation could have operational and financial implications for county employee health insurance plans and county-administered healthcare systems. Counties that sponsor employee health coverage may need to review plan designs, pharmacy benefit structures, and cost projections to ensure compliance with the revised coverage requirements by 2028. While the reduction from a 12-month to a six-month supply may lessen some potential cost and supply-chain concerns raised under earlier versions of the proposal, counties could still see modest increases in prescription-related expenditures or administrative coordination requirements associated with expanded hormone therapy coverage mandates.