Under current Illinois law, there’s nothing that prevents coverage changes during the course of the policy year when participants are locked into their plans. These midyear changes in coverage often cause “non-medical switching” – the practice in which stable patients are forced off their original medications, regardless of clinician recommendations and health consequences.
RHA joined with partners to support legislation that prevents insurers from changing co-pays or coverage of medicines during a plan year. The legislation, HB 4146, passed the Illinois House Insurance: Health and Life committee and awaits a hearing of the full House of Representatives.
The issue of non-medical switching was brought to our attention by our friends at University of Illinois at Chicago pharmacy. Many patients with chronic health issues, including respiratory diseases, are being forced off their current medications or prices shift for their medication. When these changes occur, other drugs may not control their symptoms adequately.
“Medical care is not one-size-fits-all,” said Matt Maloney, Director of Health Policy at Respiratory Health Association. “Making coverage decisions based solely on cost and forcing patients to change can cause unnecessary anxiety, all while ignoring the complexities that inform a patient’s individual care plan.”
We believe that when families in Illinois carefully shop for a health plan that covers the benefits they need, they should be guaranteed the coverage they signed up for the duration of the policy year.
It is especially important that patients who rely on medications to keep their health stable can purchase insurance coverage without fear that their benefits will be changed or be eliminated during the policy year.
HB 4146 is sponsored by State Representative Laura Fine and has bipartisan support with more than 50 other co-sponsors.
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