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| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1636 Introduced 2/8/2023, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
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Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for the purpose of removing barriers to the timely treatment of serious mental illnesses, prior authorization mandates and utilization management controls shall not be imposed under the fee-for-service and managed care medical assistance programs on any FDA-approved prescription drug that is recognized by a generally accepted standard medical reference as effective in the treatment of conditions specified in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Provides that the following shall be permitted for prescription drugs covered under the amendatory Act: (i) clinically appropriate drug utilization review (DUR) edits, including, but not limited to, drug-to-drug, drug-age, and drug-dose; (ii) generic drug substitution if a generic drug is available for the prescribed medication in the same dosage and formulation; and (iii) any utilization management control that is necessary for the Department of Healthcare and Family Services to comply with any current consent decrees or federal waivers. Defines "serious mental illness".
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| | A BILL FOR |
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| | SB1636 | | LRB103 28601 KTG 54982 b |
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| 1 | | AN ACT concerning public aid.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Public Aid Code is amended by |
| 5 | | adding Section 5-5.12f as follows:
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| 6 | | (305 ILCS 5/5-5.12f new) |
| 7 | | Sec. 5-5.12f. Prescription drugs for mental illness; no |
| 8 | | utilization or prior approval mandates. |
| 9 | | (a) Notwithstanding any other provision of this Code to |
| 10 | | the contrary, except as otherwise provided in subsection (b), |
| 11 | | for the purpose of removing barriers to the timely treatment |
| 12 | | of serious mental illnesses, prior authorization mandates and |
| 13 | | utilization management controls shall not be imposed under the |
| 14 | | fee-for-service and managed care medical assistance programs |
| 15 | | on any FDA-approved prescription drug that is recognized by a |
| 16 | | generally accepted standard medical reference as effective in |
| 17 | | the treatment of conditions specified in the most recent |
| 18 | | Diagnostic and Statistical Manual of Mental Disorders |
| 19 | | published by the American Psychiatric Association. |
| 20 | | (b) The following shall be permitted for prescription |
| 21 | | drugs covered under this Section: |
| 22 | | (1) clinically appropriate drug utilization review |
| 23 | | (DUR) edits, including, but not limited to, drug-to-drug, |