Advocacy in Illinois

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State Fact Sheet 
Find out how arthritis affects people in Illinois and what you can do to make a difference. 

 

What is step therapy?  

Step therapy is a practice used by insurers that requires people with arthritis to try lower-cost medications before permitting more expensive treatments, even when the doctor wants to prescribe them. In other words, more expensive and effective drugs can only be prescribed if the cheaper ones prove ineffective.  

How does this new law address step therapy in Illinois?  

In 2016, Illinois passed legislation to address step therapy and the law went into effect in early 2018. This new law increases the ability of the patient’s health care provider, not insurance company, to make important decisions about a patient’s treatment. If an insurer denies a request (within 72 hours or 24 for expedited), they must provide a reason.  Medical exceptions shall be approved if required drug is contraindicated, patient has tried and failed under current or previous or the patient is stable on prescription drug selected by his or her health care provider.  

Which patients will benefit from this new law?  

This law is not applicable to patients who have Medicare, Medicaid or ERISA-protected, self-insured plans. To learn if you are covered, contact your insurer and provide your policy number.  

What should I do if I experience this barrier to care in Illinois?  

If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. You can easily find instructions on how to appeal, request an external review, or file a complaint to your Insurance Commissioner with our Department of Insurance one pager, click here to learn more. 

Download our slideshow about Step Therapy in Illinois. View our handout explaining the new law here.