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.


LRB103 37189 KTG 67308 b

 

 

A BILL FOR

 

HB4777LRB103 37189 KTG 67308 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-55 as follows:
 
6    (305 ILCS 5/5-55 new)
7    Sec. 5-55. Coverage for nonopioid medications; pain relief
8parity.
9    (a) Required coverage for nonopioid medications.
10Notwithstanding any provision of law to the contrary, whenever
11a licensed health care practitioner prescribes a nonopioid
12medication for the treatment of acute pain, neither the
13Department nor a managed care organization contracted with the
14Department shall deny coverage of the nonopioid prescription
15drug in favor of an opioid prescription drug or require a
16patient to try an opioid prescription drug prior to providing
17coverage of the nonopioid prescription drug.
18    (b) Pain relief parity. In establishing and maintaining
19the Illinois Medicaid Preferred Drug List, the Department
20shall ensure that no nonopioid drug approved by the U.S. Food
21and Drug Administration for the treatment or management of
22pain shall be disadvantaged or discouraged with respect to
23coverage relative to any opioid or narcotic drug for the

 

 

HB4777- 2 -LRB103 37189 KTG 67308 b

1treatment or management of pain on the Illinois Medicaid
2Preferred Drug List, where impermissible disadvantaging or
3discouragement includes, without limitation: designating any
4such nonopioid drug as a nonpreferred drug if any opioid or
5narcotic drug is designated as a preferred drug; or
6establishing more restrictive or more extensive utilization
7controls, including, but not limited to, more restrictive or
8more extensive prior authorization or step therapy
9requirements, for such nonopioid drug than the least
10restrictive or extensive utilization controls applicable to
11any such opioid or narcotic drug.
12    This subsection applies to a nonopioid drug immediately
13upon its approval by the U.S. Food and Drug Administration for
14the treatment or management of pain, regardless of whether
15such drug has been reviewed by the Department for inclusion on
16the Illinois Medicaid Preferred Drug List. This subsection
17also applies to drugs provided under a contract between the
18Department and a managed care organization.