SPRINGFIELD - Insurance companies will be required to offer working families a flat-dollar copay plan for drug-related benefits because of a law sponsored by State Senator Napoleon Harris, III (D-Harvey). 

“A fixed out-of-pocket amount will be better for those families who have smaller budgets and need consistency,” Harris said. “I strongly believe this will be beneficial for our working families in Illinois, as it will give them the option to budget their medical expenses more easily.”

Currently, most health insurance plans have a structure for prescription drug copayments based on graduated tiers. For the highest levels of drugs, often called specialty care drugs, these plans usually use coinsurance – requiring patients to pay a percentage of the drug’s cost – rather than a copay.

This law would require at least 10% of individual plans and one group plan to offer flat out-of-pocket payments by Jan. 1, 2023, and at least 25% of individual plans and two group plans to offer that benefit by Jan. 1, 2024.

House Bill 1745 was signed by the governor and will be effective Jan. 1, 2023.