HB4777 103RD GENERAL ASSEMBLY

LRB103 37189 KTG 67308 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4777

Introduced 2/6/2024, by Rep. Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-55 new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, notwithstanding any provision of law to the contrary, whenever a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, neither the Department of Healthcare and Family Services nor a managed care organization contracted with the Department shall deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or require a patient to try an opioid prescription drug prior to providing coverage of the nonopioid prescription drug. Provides that in establishing and maintaining the Illinois Medicaid Preferred Drug List, the Department shall ensure that no nonopioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the Illinois Medicaid Preferred Drug List, where impermissible disadvantaging or discouragement includes, without limitation: designating any such nonopioid drug as a nonpreferred drug if any opioid or narcotic drug is designated as a preferred drug; or establishing more restrictive or more extensive utilization controls, including, but not limited to, more restrictive or more extensive prior authorization or step therapy requirements, for such nonopioid drug than the least restrictive or extensive utilization controls applicable to any such opioid or narcotic drug. Makes the provisions of the amendatory Act applicable to (i) a nonopioid drug immediately upon its approval by the U.S. Food and Drug Administration for the treatment or management of pain, regardless of whether such drug has been reviewed by the Department for inclusion on the Illinois Medicaid Preferred Drug List and (ii) drugs provided under a contract between the Department and a managed care organization.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Section 5-55 as follows:

(305 ILCS 5/5-55 new)

Sec. 5-55. Coverage for nonopioid medications; pain relief parity.

(a) Required coverage for nonopioid medications. Notwithstanding any provision of law to the contrary, whenever a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, neither the Department nor a managed care organization contracted with the Department shall deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or require a patient to try an opioid prescription drug prior to providing coverage of the nonopioid prescription drug.

(b) Pain relief parity. In establishing and maintaining the Illinois Medicaid Preferred Drug List, the Department shall ensure that no nonopioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the Illinois Medicaid Preferred Drug List, where impermissible disadvantaging or discouragement includes, without limitation: designating any such nonopioid drug as a nonpreferred drug if any opioid or narcotic drug is designated as a preferred drug; or establishing more restrictive or more extensive utilization controls, including, but not limited to, more restrictive or more extensive prior authorization or step therapy requirements, for such nonopioid drug than the least restrictive or extensive utilization controls applicable to any such opioid or narcotic drug.

This subsection applies to a nonopioid drug immediately upon its approval by the U.S. Food and Drug Administration for the treatment or management of pain, regardless of whether such drug has been reviewed by the Department for inclusion on the Illinois Medicaid Preferred Drug List. This subsection also applies to drugs provided under a contract between the Department and a managed care organization.