Lawmakers OK the measure to ban ‘step therapy’ insurance

SPRINGFIELD – Health care initiatives pushed by Gov. JB Pritzker passed the Illinois House on Saturday, paving the way for a ban on controversial insurance industry practices such as requiring patients to try treatments that differ from those prescribed. by their doctors.

The passage of the legislation, which followed earlier approvals by the state Senate, marks a victory for Pritzker, who in his February budget speech pledged to spend political capital to go after insurance practices he criticized as “predatory “. He then toured the state to promote the legislation.

“Today, we celebrate a victory for Illinois families and health care providers everywhere. We’re saving lives and making the path to care easier for everyone,” the governor said in a statement Saturday.

After a series of amendments to the bill, the insurance industry dropped its opposition to the legislation on most of the governor’s initiatives, except for a ban on some high-cost, short-term insurance plans.

One of the key provisions in the legislation passed by lawmakers would impose bans on what is known as step therapy, in which insurers require patients to try a different, often cheaper, alternative before the treatment recommended by doctors. The practice has been condemned by doctors and patients who say it can delay needed care, allowing patients’ conditions to deteriorate; the insurance industry has adapted it as a cost-saving measure.

In the version that passed both chambers, the space therapy provisions for prescription drugs apply to drugs already covered under insurance plans, Laura Minzer, president of the Illinois Life and Health Insurance Council, said Saturday.

For example, if a doctor wanted a patient to try Ozempic, it could be prescribed immediately if it was already on the list of medications covered by the patient’s insurance.

If Ozempic wasn’t on that list, there would still be an additional process to try to get an exemption, such as for cases where the patient had been successfully taking a certain medication for a long time. This process keeps costs down, Minzer said.

The step therapy provision, along with many others in the bill, takes effect in 2026.

The legislation would end up costing $35 million for the state insurance plan and $30 million for Medicaid, according to Democratic Rep. Anna Moeller of Elgin, the bill’s lead sponsor.

Moeller has previously said many of the reforms will lead to long-term cost savings as well as greater access to care.

Legislation containing the step therapy ban passed 83-23-1 in the House and 45-14 in the Senate, with bipartisan support.

Another of Pritzker’s initiatives — originally approved as a package with other provisions but placed in a separate bill for final votes — would ban short-term insurance plans that can be financially risky for consumers. . Known as short-term limited duration plans, they offer coverage for a short period but can result in exorbitant costs for treatment. Pritzker has called them “unsolicited plans.”

The plans are “giving people, who are more often in the middle of jobs, a false sense of security when in fact they are flying without a parachute,” Rep. Bob Morgan, D-D., said on the House floor Saturday. Deerfield.

The Illinois Life and Health Insurance Council, which represents several companies that sell short-term plans banned by the legislation, opposed the ban, and the vote to pass it in the House was 72-35, nearly split along party lines.

“These plans are not idle plans. There are some that are bare bones. The vast majority of these that are sold are with good, decent restrictions that provide value to our Illinois citizens,” said Republican Jeff Keicher of Sycamore.

The plans can be cheaper than the temporary coverage extension option known as COBRA, he said.

The bill passed Saturday that bans step therapy would also ban prior authorization, where patients must get permission from insurance companies before receiving treatment, for inpatient mental health care.

Other provisions, such as stricter standards for updating directories and posting lists of covered drugs, are intended to improve transparency. The legislation was also intended to address price increases for large group insurance.

“For too long, insurance companies, not doctors, have determined what treatment options patients should have and how soon they can get it,” Pritzker said at one of several press conferences promoting the legislation in recent weeks. “This bill puts the power back in the hands of patients and their doctors.”

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