Looming Step Therapy Ban In Illinois Is ‘Game Changer,’ Could Start Trend

Federal legislation on PBM reforms has stalled, but state efforts remain active. Illinois’ Healthcare Protection Act includes several other limits on insurer power, including prohibiting prior authorization for inpatient mental health care.

Illinois step therapy
Will Illinois’ step therapy ban spread across the map? • Source: Nielsen Hobbs; the Pink Sheet | Shutterstock images

Illinois’ new Healthcare Protection Act (HPA) includes a first-in-the-nation banning of step therapy for covered services, a provision that health policy experts expect could be copied by other states.

Key Takeaways
  • Eliminating step therapy is a popular policy, but insurers warn that it could have consequences for premiums.

  • Insurers won some modifications to the legislation, including delaying the implementation and limiting application to only on-formulary products.

  • Federal legislation to reform PBMs remains stalled, but patient advocates are hoping for action after the election

Democratic Gov. JB Pritzker, who proposed the HPA in his fiscal year 2025 budget address in February, is soon expected to sign the act

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