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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB4068

Introduced 2/24/2026, by Sen. Sara Feigenholtz

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.60
215 ILCS 200/52 new

Amends the Illinois Insurance Code. Provides that, on and after the
effective date of the amendatory Act, coverage for all abortifacients,
hormonal therapy medication, human immunodeficiency virus pre-exposure
prophylaxis, and post-exposure prophylaxis drugs approved by the United
States Food and Drug Administration, and follow-up services related to
that coverage, shall include screenings for pre-PrEP HIV and sexually
transmitted infections. Provides that the coverage shall also include
kidney function analysis, routine laboratory testing, and routine provider
visits associated with those screenings. Amends the Prior Authorization
Reform Act. Prohibits a health insurance issuer from requiring prior
authorization for the following prescription drug types and their
therapeutic equivalents approved by the United States Food and Drug
Administration: human immunodeficiency virus pre-exposure prophylaxis and
post-exposure prophylaxis medication or human immunodeficiency virus
treatment medication. Effective January 1, 2028.
LRB104 19356 BAB 32804 b

A BILL FOR

SB4068
LRB104 19356 BAB 32804 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 Illinois Insurance Code is amended by
5
changing Section 356z.60 as follows:

6

(215 ILCS 5/356z.60)
7

Sec. 356z.60.
Coverage for abortifacients, hormonal
8
therapy, and human immunodeficiency virus pre-exposure
9
prophylaxis and post-exposure prophylaxis.
10

(a) As used in this Section:
11

"Abortifacients" means any medication administered to
12
terminate a pregnancy as prescribed or ordered by a health
13
care professional.
14

"Health care professional" means a physician licensed to
15
practice medicine in all of its branches, licensed advanced
16
practice registered nurse, or physician assistant.
17

"Hormonal therapy medication" means hormonal treatment
18
administered to treat gender dysphoria.
19

"Therapeutic equivalent version" means drugs, devices, or
20
products that can be expected to have the same clinical effect
21
and safety profile when administered to patients under the
22
conditions specified in the labeling and that satisfy the
23
following general criteria:

SB4068
- 2 -
LRB104 19356 BAB 32804 b
1

(1) it is approved as safe and effective;
2

(2) it is a pharmaceutical equivalent in that it:
3

(A) contains identical amounts of the same active
4

drug ingredient in the same dosage form and route of
5

administration; and
6

(B) meets compendial or other applicable standards
7

of strength, quality, purity, and identity;
8

(3) it is bioequivalent in that:
9

(A) it does not present a known or potential
10

bioequivalence problem and it meets an acceptable in
11

vitro standard; or
12

(B) if it does present such a known or potential
13

problem, it is shown to meet an appropriate
14

bioequivalence standard;
15

(4) it is adequately labeled; and
16

(5) it is manufactured in compliance with Current Good
17

Manufacturing Practice regulations adopted by the United
18

States Food and Drug Administration.
19

(b) An individual or group policy of accident and health
20
insurance amended, delivered, issued, or renewed in this State
21
on or after January 1, 2024 shall provide coverage for all
22
abortifacients, hormonal therapy medication, human
23
immunodeficiency virus pre-exposure prophylaxis, and
24
post-exposure prophylaxis drugs approved by the United States
25
Food and Drug Administration, and follow-up services related
26
to that coverage, including, but not limited to, management of

SB4068
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LRB104 19356 BAB 32804 b
1
side effects, medication self-management or adherence
2
counseling, risk reduction strategies, and mental health
3
counseling. This coverage shall include drugs approved by the
4
United States Food and Drug Administration that are prescribed
5
or ordered for off-label use for the purposes described in
6
this Section.
On and after the effective date of this
7
amendatory Act of the 104th General Assembly, this coverage
8
shall include screenings for pre-PrEP HIV and sexually
9
transmitted infections. The coverage shall also include kidney
10
function analysis, routine laboratory testing, and routine
11
provider visits associated with those screenings.
12

(c) The coverage required under subsection (b) is subject
13
to the following conditions:
14

(1) If the United States Food and Drug Administration
15

has approved one or more therapeutic equivalent versions
16

of an abortifacient drug, a policy is not required to
17

include all such therapeutic equivalent versions in its
18

formulary so long as at least one is included and covered
19

without cost sharing and in accordance with this Section.
20

(2) If an individual's attending provider recommends a
21

particular drug approved by the United States Food and
22

Drug Administration based on a determination of medical
23

necessity with respect to that individual, the plan or
24

issuer must defer to the determination of the attending
25

provider and must cover that service or item without cost
26

sharing.

SB4068
- 4 -
LRB104 19356 BAB 32804 b
1

(3) If a drug is not covered, plans and issuers must
2

have an easily accessible, transparent, and sufficiently
3

expedient process that is not unduly burdensome on the
4

individual or a provider or other individual acting as a
5

patient's authorized representative to ensure coverage
6

without cost sharing.
7

The conditions listed under this subsection (c) also apply
8
to drugs prescribed for off-label use as abortifacients.
9

(d) Except as otherwise provided in this Section, a policy
10
subject to this Section shall not impose a deductible,
11
coinsurance, copayment, or any other cost-sharing requirement
12
on the coverage provided. The provisions of this subsection do
13
not apply to coverage of procedures to the extent such
14
coverage would disqualify a high-deductible health plan from
15
eligibility for a health savings account pursuant to the
16
federal Internal Revenue Code, 26 U.S.C. 223.
17

(e) Except as otherwise authorized under this Section, a
18
policy shall not impose any restrictions or delays on the
19
coverage required under this Section.
20

(f) The coverage requirements in this Section for
21
abortifacients do not, pursuant to 42 U.S.C. 18054(a)(6),
22
apply to a multistate plan that does not provide coverage for
23
abortion.
24

(g) If the Department concludes that enforcement of any
25
coverage requirement of this Section for abortifacients may
26
adversely affect the allocation of federal funds to this

SB4068
- 5 -
LRB104 19356 BAB 32804 b
1
State, the Department may grant an exemption to that
2
requirement, but only to the minimum extent necessary to
3
ensure the continued receipt of federal funds.
4
(Source: P.A. 102-1117, eff. 1-13-23; 103-462, eff. 8-4-23.)

5

Section 10.
The Prior Authorization Reform Act is amended
6
by adding Section 52 as follows:

7

(215 ILCS 200/52 new)
8

Sec. 52.
Prior authorization for certain prescription
9
drugs; prohibited.
A health insurance issuer may not require
10
prior authorization for the following prescription drug types
11
and their therapeutic equivalents approved by the United
12
States Food and Drug Administration: human immunodeficiency
13
virus pre-exposure prophylaxis and post-exposure prophylaxis
14
medication or human immunodeficiency virus treatment
15
medication.

16

Section 99.
Effective date.
This Act takes effect January
17
1, 2028.

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