After a two-year effort put forth by the Illinois Fair Care Coalition, a group of patient and provider groups co-led by U.S. Pain Foundation and the Arthritis Foundation, children and adults living with chronic conditions will no longer face potentially harmful prescription coverage changes during the health plan year. Governor Bruce Rauner signed House Bill 4146 into law at the end of August, a bipartisan measure that will help protect families from an unfair insurance practice known as non-medical switching.

“Across the country, people who rely on prescription medications, which are sometimes life-saving therapies, to manage their chronic condition are forced off those modalities for non-medical reasons,” explains Director of State Advocacy and Alliance Development, Shaina Smith. “The practice of non-medical switching is unfair and unethical. I’m grateful Governor Rauner recognized the loophole that existed in the state and has taken action to protect patients.”

Illinois now joins Nevada, California, Louisiana, Texas, and Maine, which all have protections in place to deter midyear formulary switching. Through the approved measure, now Public Act 100-1052, health plans can no longer remove a medication from its formulary or move the drug to an insurer-preferred cost-sharing tier. Health plans in Illinois must now adhere to the following:

  • • Notify patients at least 60 days prior to any changes are made to their prescription coverage
  • • Provide steps for impacted individuals to take to request coverage determinations and exceptions
  • • Alert the prescribing clinician of any changes to be made to the patient’s therapy option
  • • Provide either a one-page form or access to an online platform where prescribers can easily request the insurer continue providing coverage because it is medically necessary for his or her patient

The Illinois Fair Care Coalition worked with bill champions Representative Laura Fine (D-17th District) and Senator Heather Steans, who secured overwhelming support in both chambers to bring the legislation to the governor’s desk. Smith commends the dedication of the coalition, bill sponsors, co-sponsors, and Illinois advocates who, collectively, put Illinois on the map as another state that embraces continuity of care for prescription health coverage.

“This entire advocacy initiative was an eye-opening experience,” Smith recalls. “After hearing that this issue spanned across all demographics through the stories that were shared from advocates and even lawmakers, there’s no question that these safeguards were long-overdue.”

The new law, which only pertains to state-regulated plans, takes effect on January 1, 2019. For more information on non-medical switching, visit www.dontswitchme.org.