Gov. JB Pritzker celebrated a partial legislative victory Thursday night when the House passed his initiative to end some practices health insurance companies use to control the amount and cost of health care services individual patients receive.
The “Healthcare Protection Act,” House Bill 5395cleared the House on a bipartisan vote of 81-25. It next moves to the Senate where Pritzker predicted it will pass easily.
“This bill will save lives and lower health care costs for millions of Illinoisans,” he said at a news conference Thursday night celebrating the House vote. “Together, we will get this bill through the Senate and land it on my desk where I’ll proudly sign it, because the people of Illinois deserve reliable and safe access to the quality care that they deserve.”
Pritzker first outlined the initiative during his State of the State address in February. It targets many of the “utilization management” practices insurance companies use to hold down costs by either denying claims or steering patients toward lower-cost options.
For example, the bill would require health insurers to use “generally accepted standards of care” when deciding whether to cover treatments recommended by a doctor.
It also bans a practice known as step therapy that is used in some prescription drug plans. That, practice, sometimes referred to as “fail first” therapy, requires patients to demonstrate that a lower-cost drug that is part of an insurance company’s preferred drug list is ineffective before the company will approve paying for a different drug prescribed by the patient’s doctor.
It also prohibits insurance companies from requiring prior authorization before covering the costs of in-patient psychiatric treatment. In circumstances where prior authorization is necessary, companies would be required to publicly post it on their websites.
In addition to those restrictions, the bill would require insurance