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HB 3335

INS CD-WEIGHT LOSS DRUGS

104th Regular Session Introduced by Thaddeus Jones

The bill caps out-of-pocket costs for a 30-day supply of covered weight-loss drugs at $200 (with annual CPI adjustments) for plans amended after Jan 1, 2026.

Rule 19(a) / Re-referred to Rules Committee
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Bill Summary · HB 3335

Summary — HB 3335 (INS CD — Weight Loss Drugs)

Status: Introduced Feb. 18, 2025; passed Illinois House May 16, 2025; currently Rule 19(a) / Re‑referred to Rules Committee (Senate). Sponsor: Rep. Thaddeus Jones. Companion: SB 1713.

Purpose / Intent

HB 3335 seeks to cap out‑of‑pocket cost sharing for covered prescription weight‑loss drugs (GLP‑1 products cited as examples) to improve patient affordability and require public and private health plans in Illinois to incorporate that cap. The bill also grants the Illinois Department of Insurance (DOI) rulemaking and enforcement authority to implement the requirement.

Key provisions

  • New cost‑sharing cap: For any group or individual accident & health insurance plan or managed care plan that is amended, delivered, issued, or renewed after January 1, 2026 and that provides coverage for prescription insulin drugs (see note below on drafting), the total amount an insured must pay for a 30‑day supply of a covered prescription weight‑loss drug (examples listed: Ozempic, Wegovy, Mounjaro) may not exceed $200 — regardless of quantity or type of covered weight‑loss drug used to fill the prescription.
  • Insurers may choose to reduce insured cost sharing to an amount below the $200 cap; the bill does not prohibit lower cost sharing.
  • Annual adjustment: On January 1 of each year the per‑30‑day limit is to be increased by the percentage change in the prior year of the medical‑care component of the Consumer Price Index for All Urban Consumers (CPI‑U, Bureau of Labor Statistics).
  • Enforcement and rules: The DOI is given authority to promulgate rules and enforce the statute.
  • Broad incorporation: The bill amends multiple Illinois statutes (including the State Employees Group Insurance Act, Counties Code, Illinois Municipal Code, School Code, Health Maintenance Organization Act, Limited Health Service Organization Act, Voluntary Health Services Plans Act, Illinois Public Aid Code, and the Illinois Insurance Code) to require coverage consistent with the new cost‑sharing limit across state and local public plans and regulated private plans.

Who is affected

  • Insured individuals covered by Illinois individual and group accident & health insurance policies and managed care plans issued, renewed, or amended after Jan. 1, 2026.
  • State and local public employer plans (state employees, counties, municipalities, school districts) and public aid programs to the extent those codes are amended to incorporate the requirement.
  • Insurers, HMOs, limited health service organizations, and voluntary health service plans doing business in Illinois.
  • Patients using GLP‑1 and other prescription weight‑loss drugs (direct beneficiary).

Effective date / timeline

  • Applies to policies/plans amended, delivered, issued, or renewed after January 1, 2026.
  • Annual CPI‑based cap adjustments begin Jan. 1 following enactment as described in the bill.

Drafting note

The bill text contains inconsistent references: it repeatedly ties the new requirement to plans that “provide coverage for prescription insulin drugs” while the operative new section (215 ILCS 5/356z.80) appears intended to cap cost sharing for prescription weight‑loss drugs (GLP‑1s). The bill also at one point refers to “insulin drug” in the CPI escalation clause. This appears to be a drafting or cross‑reference issue that could require clarification in amendment or conference.

Likely impacts (overview)

  • Lower out‑of‑pocket costs for patients using covered weight‑loss drugs (cap of $200 per 30‑day supply, subject to CPI adjustments).
  • Increased prescription coverage costs for payers (insurers and public employer plans), which could affect premiums, plan design, or state/local budgets.
  • Administrative/implementation work for DOI and insurers to define covered drugs, apply the cap, and implement CPI adjustments.

Legislative history: Introduced in House Feb 18, 2025; passed House May 16, 2025; received in Senate and currently re‑referred under Rule 19(a) to Rules Committee.

Compiled from official sources — confirm details with the bill’s official record.

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