A host of bills mandating health care coverage, regulating pharmaceutical practices and targeting specific health issues go into effect in Illinois for 2026, many on the first day of the year. [Crains]
With one major piece of legislation passed in 2025, the Prescription Drug Affordability Act, Illinois joins numerous other states that have taken aim at the practices of pharmacy benefit managers.
The act will forbid pharmacy benefit managers — or PBMs — from steering people to specific pharmacies or companies; limiting access to a covered drug by designating it a specialty drug, contrary to the drug's definition; and engaging in spread pricing, the practice of charging insurance plans more than they reimburse pharmacies for and keeping the difference.
In addition, the law levies a fee, per covered member, on PBMs that will be used to fund up to $25 million a year in grants to independent pharmacies and pharmacies located in rural counties, medically underserved areas, low-income communities and pharmacies that serve high concentrations of Medicaid patients.
Coverage considerations
Each year, Illinois legislators find specific health conditions, drugs and therapies they want to ensure can't be carved out of health coverage. The 2025 General Assembly sessions was no exception.
Health insurers will now have to ensure that when a patient receives neonatal intensive care at a nonparticipating provider or nonparticipating facility, the beneficiary, insured or enrollee will not incur greater out-of-pocket costs than he or she would have incurred with a participating provider or a participating facility, as long as the nonparticipating provider or nonparticipating facility bills the neonatal intensive care as emergency services.
Health plans must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual.
Health maintenance organizations will be required to cover certain at-home pregnancy tests and certain medically necessary treatments to address a major injury to the jaw.
And starting on Jan. 1, 2027, insurers must also provide continuity of care for beneficiaries, in that a network plan shall permit the beneficiary to continue an ongoing course of treatment with that provider during a transitional period for 90 days after notifying a beneficiary that a provider is pulling out of a network plan.
Also starting in 2027, health insurers must cover medically necessary diagnostic testing and FDA-approved treatments or medications prescribed to slow the progression of Alzheimer’s disease or another related dementia. They also must cover medically necessary horse-riding therapy or services that "incorporate equine movement as part of a therapeutic intervention."
And in 2027, insurers must find non-opioid pain medications. Health insurers must develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-opioid, non-narcotic pain management services and non-medication pain management that serve as alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed by the state Department of Insurance.
Health plans must also tell their enrollees about these laws. Each year, health plans must provide, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by state law or administrative rule, highlighting any newly enacted state law or administrative rule.
Emergency, and not so emergency, services
In 2026, all 911 telecommunicators who are dispatching emergency services must be trained in "high-quality telecommunicator cardiopulmonary resuscitation (T-CPR)." The training would instruct 911 dispatchers on how to talk a caller through providing CPR.
People who, acting in good faith, administer an epinephrine delivery system in an emergency will not be liable for civil damages to a person who was given the epinephrine shot, except for in the case of willful and wanton misconduct.
Fire departments and fire protection districts may now begin charging nursing homes and assisted living facilities for nonemergency lift-assist services — calls to lift a patient into a bed, for instance — after the sixth time safety employees are called to a location in a year.
The state is taking a cue from Chicago by mandating the opioid overdose medication naloxone be made available at all public libraries across the state, and requiring at least one staff member be trained to identify overdoses and to administer the drug, typically a nasal spray.
The Office of the State Fire Marshal will begin tracking the manner of death for all firefighters in Illinois, including suicide and types of cancer.
Employers will have to allow part-time employees, as well as full-timers, to use up to 10 days of leave in any 12-month period to serve as an organ donor. It also provides that, for a part-time worker using leave to serve as an organ donor, the employer has to calculate their daily average pay during the previous two months and compensate them with that average for the leave days used.
The Illinois Department of Human Services' Office to Prevent & End Homelessness will begin to maintain a website on how a hospital or health care provider may connect a patient with a homeless shelter or homeless support services. The law taking effect Jan. 1 also requires the department to include on its website a way for the hospital or provider to determine which continuum of care applies, based on the facility's physical location.
Beyond health care, the Illinois Municipal League provides a comprehensive list of all kinds of state legislation "of municipal interest" that take effect in 2026 and 2027.
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