House panel OKs bill to prevent health insurance modifications

April 10--Legislation that would prevent insurance companies from modifying coverage of customers locked into health plans cleared an Illinois House committee Monday.

House Bill 4146, which passed 9-5, would prevent insurance companies from increasing out-of-pocket costs for a covered drug, moving a prescription drug to a more restrictive tier or removing it from a formulary during the length of a locked-in agreement.

Supporters argue it is consumer-friendly legislation that will help patients afford medications by avoiding "bait-and-switch" situations that cause drug prices to skyrocket.

"A good example of it is if you sign up for a year lease on an apartment, your landlord can't come back to you three months later and say we're raising the rent," said state Rep. Laura Fine, D-Glenview, the bill's main sponsor. "And that's the same thing we want to do with medication."

Fine said people often will sign up for a particular health insurance plan because medication they need is covered under their contract. While consumers are not allowed to change their plan midway, insurance companies can drop a certain drug from the formulary, putting consumers in a bind.

Opponents say the bill punishes employers and consumers. They say that it effectively serves as a "giveaway" to the pharmaceutical industry, who they argue is the real problem.

"The central issue we should be focused on is the rising cost of prescription drugs," said Scott Woods, representing the Pharmaceutical Care Management Association. "And this bill is a diversion from that central focus that we should be having. Brand manufacturers want the public to think that there's a coverage problem and not a cost problem."

The bill's requirements would not apply to health plans for Medicaid enrollees and state workers. Insurers would still be allowed to add potentially cheaper generic medications to their list of covered drugs.

Fine said the bill still needs some refinement and, with an amendment, it is likely to come back to committee before a full House vote.

Contact Brenden Moore: 782-3095, bmoore@sj-r.com, twitter.com/brendenmore13.

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