SB2328 103RD GENERAL ASSEMBLY

LRB103 30756 KTG 57238 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2328

Introduced 2/10/2023, by Sen. Laura M. Murphy

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.12f new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023, all non-controlled FDA-approved prescription medications for the treatment of a serious mental illness shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who are diagnosed with a mental disorder that meets criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and which is the focus of the treatment provided, including, but not limited to, schizophrenia, schizo-affective disorders, bipolar disorders, or major depression. Exempts medications covered under the amendatory Act from any prior authorization or lifetime restriction limit mandate. Provides that, for any covered medication that contains an opioid antagonist, the prescriber shall check the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid. Requires a prescriber of any medication covered under the amendatory Act to be a board-certified psychiatrist or a medical professional with prescribing authority that routinely treats patients with a serious mental illness. Effective July 1, 2023.

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 1. Findings. The General Assembly finds that:

(1) The Department of Human Services identifies persons with a serious mental illness as those individuals who have a diagnosis that meets the diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and which is the focus of the treatment being provided, such as schizophrenia, schizophreniform disorder, schizo-affective disorder, delusional disorder, shared psychotic disorder, brief psychotic disorder, psychotic disorder, bipolar disorder NOS, cyclothymic disorder, major depression, obsessive-compulsive disorder, anorexia nervosa, and bulimia nervosa.

(2) Annually, more than 380,000 emergency department visits in the U.S. involve adults with schizophrenia. According to the National Center for Health Statistics, 32.7% of these emergency department visits result in a hospital admission while 16.7% of these visits result in a transfer to a psychiatric hospital.

(3) In its July 2021 Statistical Brief #278, the Agency for Healthcare Research and Quality identified schizophrenia as the 7th most common diagnosis among adults for hospital readmissions across all insurers in 2018.

(4) Serious mental illnesses can be effectively treated with medications approved by the federal Food and Drug Administration (FDA).

(5) Other states, including Michigan, Indiana, Ohio, Missouri, Texas, Florida, Georgia, Connecticut, Hawaii, Oregon, Arizona, and Maine, have recognized the importance of patient access to FDA-approved medications for the treatment of a serious mental illness and have removed prior authorization barriers to those FDA-approved medications.

(6) Illinois has a shortage of mental health providers. FDA-approved medications for the treatment of a serious mental illness should be available to all providers with prescriptive authority in the State, including medical doctors, osteopathic doctors, physicians assistants, and nurse practitioners.

(7) The Illinois Medicaid Preferred Drug List already includes FDA-approved medications that do not require prior authorization and that have a safety and tolerability profile equivalent to FDA-approved medications for the treatment of a serious mental illness that do require prior authorization.

(8) Annually, this State issues an estimated 60,000 prescription medications that do not require prior authorization and that have a safety and tolerability profile that is equivalent to FDA-approved medications for the treatment of a serious mental illness that do require prior authorization.

(9) As a matter of professional practice, Illinois health care providers who prescribe FDA-approved medications that contain an opioid antagonist first consult the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid.

(10) The removal of prior authorization requirements for FDA-approved medications for the treatment of a serious mental illness would have no impact on any federally-mandated drug rebates Illinois receives from drug manufactures under the Medicaid Drug Rebate Program.

Section 5. The Illinois Public Aid Code is amended by adding Section 5-5.12f as follows:

(305 ILCS 5/5-5.12f new)

Sec. 5-5.12f. Non-controlled prescription medications to treat mental illness.

(a) As used in this Section:

"DSM-5 criteria" means the diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

"FDA" means the United States Food and Drug Administration.

(b) Notwithstanding any other provision of this Code to the contrary, on and after July 1, 2023, all non-controlled FDA-approved prescription medications for the treatment of a serious mental illness, as defined by the Department of Human Services, shall be covered under the medical assistance program for persons otherwise eligible for medical assistance who are diagnosed with a mental disorder that meets DSM-5 criteria and which is the focus of the treatment provided, including, but not limited to, schizophrenia, schizo-affective disorders, bipolar disorders, or major depression. Prescription medications covered under this Section shall not be subject to any prior authorization mandate or lifetime restriction limit mandate. For any medication covered under this Section that contains an opioid antagonist, the prescriber shall check the Illinois Prescription Monitoring Program to determine if the patient is being actively prescribed an opioid. The prescriber of a non-controlled FDA-approved prescription medication must be a board-certified psychiatrist or a medical professional with prescribing authority that routinely treats patients with a serious mental illness.

Section 99. Effective date. This Act takes effect July 1, 2023.