PRIOR AUTH-PRESCRIPTION DRUGS

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Introduced

Senate Amendment 001

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB1258

Introduced 1/28/2025, by Sen. Graciela Guzmán

SYNOPSIS AS INTRODUCED:

215 ILCS 200/52 new

Amends the Prior Authorization Reform Act. Provides that a health
insurance issuer may not require prior authorization for: a prescription
drug prescribed to a patient by a health care professional for 6 or more
consecutive months, regardless of whether the prescription drug is a
non-preferred medication pursuant to the patient's health insurance
coverage; the following prescription drugs or the therapeutic equivalent
approved by the United States Food and Drug Administration: insulin; human
immunodeficiency virus prevention medication; human immunodeficiency virus
treatment medication; viral hepatitis medication; estrogen; and
progesterone; or human immunodeficiency virus pre-exposure prophylaxis and
post-exposure prophylaxis drugs approved by the United States Food and
Drug Administration; Truvada; Harvoni; Descovy; and Apretude.
LRB104 08130 BAB 18176 b

A BILL FOR

SB1258
LRB104 08130 BAB 18176 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Prior Authorization Reform Act is amended
5
by adding Section 52 as follows:

6

(215 ILCS 200/52 new)
7

Sec. 52.
Prior authorization prohibited.
A health
8
insurance issuer may not require prior authorization for:
9

(1) a prescription drug prescribed to a patient by a
10

health care professional for 6 or more consecutive months,
11

regardless of whether the prescription drug is a
12

non-preferred medication pursuant to the patient's health
13

insurance coverage;
14

(2) the following prescription drugs or the
15

therapeutic equivalent approved by the United States Food
16

and Drug Administration: insulin; human immunodeficiency
17

virus prevention medication; human immunodeficiency virus
18

treatment medication; viral hepatitis medication;
19

estrogen; and progesterone; or
20

(3) human immunodeficiency virus pre-exposure
21

prophylaxis and post-exposure prophylaxis drugs approved
22

by the United States Food and Drug Administration;
23

Truvada; Harvoni; Descovy; and Apretude.

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