On August 21, 2018 Governor Rauner signed into law SB3046 (Public Act 100-1017). SB3046 was an initiative of IRTA's. The bill provides that on and after the effective date of this amendatory Act, eligible TRS benefit recipients and TRS dependent beneficiaries may elect to participate in TRIP (this includes participants in TRAIL) if they previously opted out of the program. The bill provides that the election must be made during the benefit recipient's annual open enrollment period, subject to specified conditions.SB3046 becomes effective immediately.
Senator Manar and Representative Gordan-Booth were the main sponsors of this legislation. In addition there were several other representatives and senators that co- sponsored the legislation.
PRESCRIPTION DRUG COVERAGE GAP
The following is an explanation from United Health Care and the State of Illinois Department of Central Management Services regarding the cost of prescriptions once a member enters the "coverage gap" and "catastrophic" coverage.
When a member enters the prescription Medicare Part D 'coverage gap' (the amount between $2,850 and $4,550) the amounts that the member pays for their prescriptions is still the copayment amount; however, the amount the member pays (i.e., the copayment) is added to any manufacturer's discount given to the plan for brand name drugs the member filled. The manufacturer's discount is usually 50% of the drug's retail value and is given to the plan (UHC/OptumRX) for the cost of the drug. It is this discount that is also added to the member's copayment that can throw them over the $4,550 amount into the 'catastrophic' coverage. Once in the catastrophic level, the member will usually end up paying 5% of the cost of the drug. All of these costs are indicated on the Explanation of Benefits (EOB) from UHC. The member will get two separate EOBs, one for medical services and one for prescriptions. The member will only receive an EOB if they had medical or prescription expenses during the month. The prescription EOB will list the name of the drug, the date it was filled, the pharmacy that filled the prescription, the tier the drug is in, what the plan paid for the drug, what the member paid for the drug (copayment) and 'other' payments, which are the manufacturer's discounts. Please see the following example:
Humera (brand name drug was discounted 50%; total cost of the drug is not on the EOB, but in this case was $5,130.36)
Plan Paid - $2,735.09
Member Paid - $50.00 (copayment)
Discount - $2,345.27
The Department of Central Management Services continues to work with United Health Care (UHC) to negotiate a fair alternative. IRTA will continue to keep our members updated on any future changes.