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HB 2680

Torts; Torts Reform Act of 2025; effective date.

2025 Regular Session Introduced by Kyle Hilbert

Illinois bill requires prescription drug plans to count all payments by or for the insured toward out-of-pocket maximums and cost sharing, with an HDHP carve-out to protect HSAs.

Second Reading referred to Rules
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Bill Summary · HB 2680

Summary — HB 2680 (Prescription drug cost‑sharing)

Subject: Illinois — Insurance Code (new Section 356z.80)
Primary sponsor: Rep. Camille Y. Lilly

Status (most recent): Pending — Rule 19(a) / Re‑referred to Rules Committee; considered in Insurance Committee (public hearing 4/9/2025) and left pending.

Note: The legislative text packet also contained an unrelated Arizona bill numbered HB 2680 (sentencing enhancements). The summary below addresses the Illinois Insurance Code proposal titled “Prescription drug cost‑sharing.”

Purpose / intent

Require health and accident insurance policies that cover prescription drugs to count all payments made by or on behalf of an insured person toward the insured’s out‑of‑pocket maximums and other cost‑sharing requirements. The intent is to ensure that third‑party payments (for example, manufacturer copay assistance or payments made by friends/family) reduce the insured’s remaining cost burden under the plan.

Key provisions

  • Adds Section 356z.80 to the Illinois Insurance Code.
  • Applies to any plan of health or accident insurance that provides coverage for prescription drugs and that is issued, amended, renewed, or delivered on or after January 1, 2027.
  • Requires insurers to include “any amount paid by the insured or paid on behalf of the insured by another person” when calculating the insured’s overall contribution toward:
    • Any out‑of‑pocket maximum, and
    • Any other cost‑sharing requirement.
  • Carves out an exception for high‑deductible health plans (HDHPs) to the extent that counting such payments would disqualify the plan from eligibility for a Health Savings Account (HSA) under Internal Revenue Code Section 223.

Who would be affected

  • Directly affects health and accident insurance policies regulated under the Illinois Insurance Code — principally fully insured individual and group policies issued in Illinois.
  • Would not automatically apply to self‑funded employer plans governed by ERISA (federal preemption may limit state law effects on those plans).
  • Insured individuals with prescription drug coverage who receive third‑party financial assistance (such as manufacturer coupons, foundations, family members) would likely reach their in‑network out‑of‑pocket maximums sooner.
  • Insurers, pharmacy benefit managers, drug manufacturers, and entities that run copay assistance programs would see programmatic and accounting effects.

Potential impacts and considerations

  • Consumer benefit: reduced net out‑of‑pocket spending for policyholders who receive third‑party payments toward drug costs.
  • Cost shifting: insurers may experience higher net payouts (since third‑party payments would count toward, rather than replace, plan cost‑sharing), possibly affecting premiums or plan design over time.
  • Operational issues: administrators will need systems/policies to identify and credit third‑party payments and to prevent double‑counting or fraud.
  • Legal limits: ERISA preemption likely limits applicability to self‑insured employer plans; further regulatory or litigation clarifications could follow.
  • HDHPs/HSA preservation: explicit carveout for HDHPs to avoid loss of HSA eligibility.

Effective date / timeline

  • The counting requirement applies to policies issued, amended, renewed, or delivered on or after January 1, 2027.

Procedural history (selected)

  • Filed with Clerk: 2/4/2025 (Rep. Camille Y. Lilly)
  • First reading: 2/6/2025
  • Assigned to Insurance Committee: 3/4/2025
  • Rule 19(a) / Re‑referred to Rules Committee: 3/21/2025
  • Public hearing — Insurance Committee: 4/9/2025 (considered; left pending)

If you want, I can draft a short plain‑language explainer for consumers or identify likely implementation questions insurers would need to resolve.

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

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