IllinoisHB1770104th General Assembly (2025–2026)House

INS-HEALTH CARE/RARE CONDITION

Sponsored By: Lindsey LaPointe (Democratic)

In Committee

Summary

Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.

insurance

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Bill Overview

No Economic Impacts Identified for this Bill

Sponsors & Cosponsors

Sponsor

  • Lindsey LaPointe

    Democratic • House

Cosponsors

  • Nicholas K. Smith

    Democratic • House

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. Rule 19(a) / Re-referred to Rules Committee

    3/21/2025House
  2. To Insurance Main Subcommittee

    3/19/2025House
  3. Added Chief Co-Sponsor Rep. Nicholas K. Smith

    3/19/2025House
  4. Assigned to Insurance Committee

    2/25/2025House
  5. Referred to Rules Committee

    1/28/2025House
  6. First Reading

    1/28/2025House
  7. Filed with the Clerk by Rep. Lindsey LaPointe

    1/27/2025House

Bill Text

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