HB5355 EngrossedLRB103 37186 RPS 67305 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Department of Public Health Powers and
5Duties Law of the Civil Administrative Code of Illinois is
6amended by adding Section 2310-730 as follows:
 
7    (20 ILCS 2310/2310-730 new)
8    Sec. 2310-730. Nonopioid alternatives pamphlet. The
9Department of Public Health shall develop and publish on its
10website an educational pamphlet regarding the use of nonopioid
11alternatives for the treatment of acute nonoperative, acute
12perioperative, subacute, or chronic pain. The pamphlet shall,
13at a minimum, conform with the most current CDC Clinical
14Practice Guideline for Prescribing Opioids for Pain published
15by the Centers for Disease Control and Prevention and shall
16include:
17        (1) information on available nonopioid alternatives
18    for the treatment of pain, including available nonopioid
19    medicinal drugs or drug products and nonpharmacological
20    therapies; and
21        (2) the advantages and disadvantages of the use of
22    nonopioid alternatives.
 

 

 

HB5355 Engrossed- 2 -LRB103 37186 RPS 67305 b

1    Section 10. The Illinois Insurance Code is amended by
2adding Section 370c.3 as follows:
 
3    (215 ILCS 5/370c.3 new)
4    Sec. 370c.3. Coverage for nonopioid medications; pain
5relief parity.
6    (a) In this Section, "health insurance issuer" has the
7meaning set forth in Section 5 of the Illinois Health
8Insurance Portability and Accountability Act.
9    (b) Notwithstanding any provision of law to the contrary,
10when a licensed health care practitioner prescribes a
11nonopioid medication for the treatment of acute pain, it shall
12be unlawful for a health insurance issuer to deny coverage of
13the nonopioid prescription drug in favor of an opioid
14prescription drug or to require the patient to try an opioid
15prescription drug prior to providing coverage of the nonopioid
16prescription drug.
17    (c) In establishing and maintaining its drug formulary, a
18health insurance issuer shall ensure that no nonopioid drug
19approved by the United States Food and Drug Administration for
20the treatment or management of pain shall be disadvantaged or
21discouraged, with respect to coverage or cost sharing,
22relative to any opioid or narcotic drug for the treatment or
23management of pain on the health insurance issuer's drug
24formulary, where impermissible disadvantaging or
25discouragement includes, without limitation: imposing more

 

 

HB5355 Engrossed- 3 -LRB103 37186 RPS 67305 b

1restrictive coverage criteria on any such nonopioid drug than
2the least restrictive coverage criteria imposed on an opioid
3or narcotic drug; establishing more restrictive or more
4extensive utilization controls, including, but not limited to,
5more restrictive or more extensive prior authorization or step
6therapy requirements, for such nonopioid drug than the least
7restrictive or extensive utilization controls applicable to
8any such opioid or narcotic drug; or, if the health insurance
9issuer maintains a drug formulary grouped into tiers for the
10purposes of determining cost sharing, placing any such
11nonopioid drug on a tier that requires a cost-sharing
12responsibility that exceeds the lowest cost-sharing
13responsibility required for any opioid or narcotic drug on the
14drug formulary. This subsection does not preclude opioid drugs
15from being preferred over other opioid drugs or nonopioid
16drugs from being preferred over other nonopioid drugs.
 
17    Section 15. The Illinois Public Aid Code is amended by
18adding Section 5-55 as follows:
 
19    (305 ILCS 5/5-55 new)
20    Sec. 5-55. Coverage for nonopioid medications; pain relief
21parity.
22    (a) Required coverage for nonopioid medications.
23Notwithstanding any provision of law to the contrary, whenever
24a licensed health care practitioner prescribes a nonopioid

 

 

HB5355 Engrossed- 4 -LRB103 37186 RPS 67305 b

1medication for the treatment of acute pain, neither the
2Department nor a managed care organization contracted with the
3Department shall deny coverage of the nonopioid prescription
4drug in favor of an opioid prescription drug or require a
5patient to try an opioid prescription drug prior to providing
6coverage of the nonopioid prescription drug.
7    (b) Pain relief parity. In establishing and maintaining
8the Illinois Medicaid Preferred Drug List, the Department
9shall ensure that nonopioid drugs preferred on the
10Department's preferred drug list, and approved by the U.S.
11Food and Drug Administration, for the treatment or management
12of pain shall not be disadvantaged or discouraged with respect
13to coverage relative to any opioid or narcotic drug for the
14treatment or management of pain.
 
15    Section 99. Effective date. Sections 10 and 15 of this Act
16take effect January 1, 2026.