PRIOR AUTHORIZATION APPROVAL

104th Regular Session Introduced by Sonya Harper and 1 co-sponsor

HB 3782 lets prior authorization for recurring services/maintenance meds stay valid for the full duration of a chronic condition or treatment, cutting repeated PA requests.

House Floor Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee

Summary — HB 3782 (Prior Authorization Approval)

Bill number: HB 3782

Primary sponsor: Rep. Sonya M. Harper (added co‑sponsor Rep. Camille Y. Lilly 4/8/2025)

Amends: Prior Authorization Reform Act (215 ILCS 200/65)

Introduced: Feb. 18, 2025 (filed with Clerk Mar. 5, 2025)

Current status (as of record): House Floor Amendment No. 1 / Re‑referred to Rules Committee; placed on General State Calendar (5/1/2025); laid on table subject to call.

Purpose / Intent

To reduce repeated prior‑authorization (PA) burden for patients with chronic conditions by making PA approvals for recurring services and maintenance medications valid for the expected duration of the chronic health condition or for the length of treatment as determined by the treating clinician, unless the standard of treatment changes.

Key provisions

Redefines "chronic health condition" as a condition that:

is expected to last one year or more and requires ongoing medical attention to manage the condition or prevent an adverse health event, or
limits one or more activities of daily living.

For recurring health care services or maintenance medications used to treat a chronic health condition, if an insurer requires prior authorization:

the PA approval shall remain valid from the date the provider receives the approval for the duration of the chronic health condition or for the length of treatment, as determined by the patient’s health care professional, unless the standard of treatment for that condition changes.

Exclusions and limits:

The section does not apply to prescriptions of benzodiazepines or Schedule II narcotic drugs (e.g., opioids).
The provision does not require an issuer to cover services that are otherwise excluded by the plan’s terms or to dispense benefits regardless of medical‑necessity rules (subject to existing statutory exceptions such as managed care prescription provisions referenced in the Act).

Who is affected

Patients with chronic health conditions — fewer interruptions and repeated PA requests for recurring treatments and maintenance medications.

Health care professionals and providers — reduced administrative work and more predictable authorizations for ongoing care.

Health insurers, pharmacy benefit managers, and payers — limits on the ability to re‑require PA for specified recurring services across the course of a chronic condition; still retain the ability to deny coverage under plan exclusions or medical necessity standards.

Pharmacies — potential operational changes for refill/authorization workflows.

Procedural/timeline notes

Referred to Insurance Committee (Mar. 11, 2025); Insurance Committee recommended Do Pass (short debate) 3/18/2025.

Public hearings and committee substitute activity occurred in April 2025; reported favorably as substituted 4/14/2025.

House Floor Amendment No. 1 (filed 3/21/2025) corrected wording (changed “health chronic” to “chronic health”).

Companion bill: SB 1062.

Potential impacts / considerations

Likely to improve continuity of care and reduce administrative burden for long‑term treatments.

Could increase insurer costs or change utilization management practices because recurring services/medications would not require repeated PA while the condition/treatment remains the same.

Safeguards remain (exclusions for certain controlled substances; coverage still subject to plan terms and medical necessity).