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Bill Regulates Specialty Drug Co-pay Maximum

From Aetna health plans:

ILLINOIS: Legislators introduced a bill last week that would require health plans providing prescription drug coverage to ensure that any required copayment or coinsurance for drugs on a specialty tier not exceed $100 per month for up to a 30-day supply of any single drug.The measure also states that a beneficiary’s annual out-of-pocket expenditures for prescription drugs should not be more than 50 percent of the dollar amounts in effect under ACA. Health plans would also be required to implement an exceptions process allowing enrollees to request an exception to the tiered cost-sharing structure. Health plans also would be prohibited from placing all drugs in a specialty class on a specialty tier.

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