103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3781

 

Introduced 2/9/2024, by Sen. Karina Villa

 

SYNOPSIS AS INTRODUCED:
 
New Act
215 ILCS 5/370c.3 new
305 ILCS 5/5-55 new

    Creates the Nonopioid Alternatives for Pain Act. Requires the Department of Public Health to develop and publish an educational pamphlet regarding the use of nonopioid alternatives for pain treatment. Provides that a health care practitioner shall exercise professional judgment in selecting appropriate treatment modalities for pain in accordance with specified Centers for Disease Control and Prevention guidelines, including the use of nonopioid alternatives whenever nonopioid alternatives exist. Requires a health care practitioner who prescribes an opioid drug to provide certain information to the patient, discuss certain topics, and document the reasons for the prescription. Requires the Department to develop a nonopioid directive form for patients. Sets forth provisions concerning exceptions, execution of a nonopioid directive, opioid administration to a patient with a nonopioid directive, and limitations of liability. Amends the Illinois Insurance Code. Provides that when a licensed health care practitioner prescribes a nonopioid medication for the treatment of acute pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug or to require the patient to try an opioid prescription drug before providing coverage. Provides that in establishing and maintaining its drug formulary, a health insurance issuer shall ensure that no nonopioid drug approved by the Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged, with respect to coverage or cost sharing, relative to any opioid or narcotic drug for the treatment or management of pain. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that 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 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. Makes other changes.


LRB103 39079 RPS 69217 b

 

 

A BILL FOR

 

SB3781LRB103 39079 RPS 69217 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 1. Short title. This Act may be cited as the
5Nonopioid Alternatives for Pain Act.
 
6    Section 3. Findings. The General Assembly finds that every
7competent adult has the fundamental right of
8self-determination regarding decisions pertaining to that
9adult's own health, including the right to refuse an opioid
10drug.
 
11    Section 5. Definitions. As used in this Act:
12    "Department" means the Department of Public Health.
13    "Emergency medical services personnel" has the meaning
14given to that term in Section 3.5 of the Emergency Medical
15Services (EMS) Systems Act.
16    "Health care practitioner" means a person licensed or
17registered by the Department of Financial and Professional
18Regulation under the following Acts: the Medical Practice Act
19of 1987, the Nurse Practice Act, the Clinical Psychologist
20Licensing Act, the Illinois Optometric Practice Act of 1987,
21the Illinois Physical Therapy Act, the Pharmacy Practice Act,
22the Physician Assistant Practice Act of 1987, the Clinical

 

 

SB3781- 2 -LRB103 39079 RPS 69217 b

1Social Work and Social Work Practice Act, the Nursing Home
2Administrators Licensing and Disciplinary Act, the Illinois
3Occupational Therapy Practice Act, the Podiatric Medical
4Practice Act of 1987, the Respiratory Care Practice Act, the
5Professional Counselor and Clinical Professional Counselor
6Licensing and Practice Act, the Illinois Speech-Language
7Pathology and Audiology Practice Act, the Illinois Dental
8Practice Act, the Illinois Dental Practice Act, or the
9Behavior Analyst Licensing Act.
10    "Nonopioid directive form" means the form developed under
11Section 20.
12    "Prescriber" has the meaning given to that term in
13subsection (mm) of Section 102 of the Illinois Controlled
14Substances Act.
 
15    Section 10. Nonopioid alternatives pamphlet. The
16Department of Public Health shall develop and publish on its
17website an educational pamphlet regarding the use of nonopioid
18alternatives for the treatment of acute nonoperative, acute
19perioperative, subacute, or chronic pain. The pamphlet shall,
20at a minimum, conform with the most current CDC Clinical
21Practice Guideline for Prescribing Opioids for Pain published
22by the Centers for Disease Control and Prevention and shall
23include:
24        (1) information on available nonopioid alternatives
25    for the treatment of pain, including available nonopioid

 

 

SB3781- 3 -LRB103 39079 RPS 69217 b

1    medicinal drugs or drug products and nonpharmacological
2    therapies; and
3        (2) the advantages and disadvantages of the use of
4    nonopioid alternatives.
 
5    Section 15. Prescription of opioids.
6    (a) A health care practitioner shall exercise professional
7judgment in selecting appropriate treatment modalities for
8acute nonoperative, acute perioperative, subacute, or chronic
9pain in accordance with the most current CDC Clinical Practice
10Guideline for Prescribing Opioids for Pain published by the
11Centers for Disease Control and Prevention, including the use
12of nonopioid alternatives whenever reasonable, clinically
13appropriate, and evidence-based alternatives exist.
14    (b) The health care practitioner shall consider
15prescribing nonopioids as the first line of pain control in
16patients, unless the prescription is not clinically
17appropriate, in accordance with subsection (a).
18    (c) Except when a patient is receiving care in a hospital
19critical care unit or emergency department or a patient is
20receiving hospice services under Hospice Program Licensing
21Act, before providing care requiring the administration of
22anesthesia involving the use of an opioid drug, or prescribing
23or ordering an opioid drug for the treatment of pain, a health
24care practitioner who prescribes or orders an opioid drug must
25do all of the following:

 

 

SB3781- 4 -LRB103 39079 RPS 69217 b

1        (1) Inform the patient or the patient's representative
2    of available nonopioid alternatives for the treatment of
3    pain, which may include available nonopioid medicinal
4    drugs or drug products, interventional procedures or
5    treatments, acupuncture, chiropractic treatments, massage
6    therapy, physical therapy, occupational therapy, or any
7    other appropriate therapy as determined by the health care
8    practitioner.
9        (2) Discuss with the patient or the patient's
10    representative the advantages and disadvantages of the use
11    of nonopioid alternatives and whether the patient is at a
12    high risk of, or has a history of, controlled substance
13    abuse or misuse and the patient's personal preferences.
14        (3) Provide the patient or the patient's
15    representative, electronically or in printed form, with
16    the educational pamphlet described in Section 10.
17        (4) Document in the patient's record that nonopioid
18    alternatives were considered and discussed with the
19    patient or the patient's representative and, to the extent
20    that the health care practitioner prescribes or orders an
21    opioid for the treatment of pain, document the reasons for
22    such a prescription or order.
 
23    Section 20. Nonopioid directive form. The Department shall
24develop a nonopioid directive form indicating to health care
25practitioners and emergency medical services personnel that,

 

 

SB3781- 5 -LRB103 39079 RPS 69217 b

1except as otherwise provided in Section 30 or in rules adopted
2by the Department, a patient who has executed the form or who
3has had a form executed on the patient's behalf must not be
4administered an opioid or offered a prescription for an
5opioid. The Department shall include on the nonopioid
6directive form instructions on how the form may be revoked and
7any other information that the Department considers relevant.
8The Department shall make the form available to the public on
9the Department's website.
 
10    Section 25. Nonopioid directive form; execution. A patient
11may execute a nonopioid directive form on his or her own
12behalf. A guardian or patient advocate of a patient may
13execute a nonopioid directive form on behalf of the patient.
14If a nonopioid directive form is executed by or on behalf of a
15patient and is presented to a health care practitioner, the
16health care practitioner shall obtain a copy of the form and
17include the copy in the patient's medical record. A patient
18may revoke a nonopioid directive form executed by himself or
19herself at any time and in any manner by which he or she is
20able to communicate his or her intent to revoke the form. A
21patient advocate or guardian may revoke a nonopioid directive
22form on behalf of a patient at any time by issuing the
23revocation in writing and providing notice of the revocation
24to the patient's health professional or his or her delegate.
 

 

 

SB3781- 6 -LRB103 39079 RPS 69217 b

1    Section 30. Administration of an opioid to a patient who
2has executed a nonopioid directive form. A prescriber who
3holds a controlled substances license or a health care
4practitioner who is a practical nurse or registered
5professional nurse and is acting on the order of the
6prescriber may administer an opioid to a patient who has
7executed a nonopioid directive form or who has had a nonopioid
8directive form executed on his or her behalf if the patient is
9being treated at a hospital or in a setting outside of a
10hospital in the case of an emergency and, in the prescriber's
11professional opinion, the administration of the opioid is
12medically necessary to treat the patient. If an opioid is
13administered under this Section, the prescriber shall ensure
14that the patient is provided with information on substance use
15disorder services.
 
16    Section 35. Limitation of liability. Except as otherwise
17provided by law, the following are not subject to civil or
18criminal liability or professional disciplinary action for
19failing to administer, prescribe, or dispense an opioid, or
20for the inadvertent administration of an opioid, to a patient
21who has executed a nonopioid directive form or who has had a
22nonopioid directive form executed on his or her behalf if the
23failure to act or the act was done reasonably and in good
24faith:
25        (1) A health care practitioner whose scope of practice

 

 

SB3781- 7 -LRB103 39079 RPS 69217 b

1    includes the prescribing, administering, or dispensing of
2    a controlled substance.
3        (2) A health facility or agency.
4        (3) An employee of a health care practitioner.
5        (4) An employee of a health facility or agency.
6        (5) Emergency medical services personnel.
 
7    Section 40. Rulemaking. The Department shall adopt rules
8to implement this Act. The rules must allow a health care
9practitioner or health facility or agency to incorporate a
10nonopioid directive form into an existing patient form or into
11other documentation used by the health care practitioner or
12health facility or agency, and the rules must include, but not
13be limited to, all of the following:
14        (1) Procedures to record a nonopioid directive form in
15    a medical record, including an electronic medical record.
16        (2) Procedures to revoke a nonopioid directive form.
17        (3) Procedures to ensure that the recording,
18    disclosure, or distribution of data relating to a
19    nonopioid directive form or the transmission of a
20    nonopioid directive form complies with State and federal
21    confidentiality and consent laws, rules, and regulations.
22        (4) Exemptions for administering or prescribing an
23    opioid to a patient who has executed a nonopioid directive
24    form or who has had a nonopioid directive form executed on
25    his or her behalf if the opioid is administered or

 

 

SB3781- 8 -LRB103 39079 RPS 69217 b

1    prescribed to treat the patient for a substance use
2    disorder.
3        (5) Exemptions for administering or prescribing an
4    opioid to a patient who has executed a nonopioid directive
5    form or who has had a nonopioid directive form executed on
6    his or her behalf if the patient is a hospice patient.
 
7    Section 100. The Illinois Insurance Code is amended by
8adding Section 370c.3 as follows:
 
9    (215 ILCS 5/370c.3 new)
10    Sec. 370c.3. Coverage for nonopioid medications; pain
11relief parity.
12    (a) In this Section, "health insurance issuer" has the
13meaning set forth in Section 5 of the Illinois Health
14Insurance Portability and Accountability Act.
15    (b) Notwithstanding any provision of law to the contrary,
16when a licensed health care practitioner prescribes a
17nonopioid medication for the treatment of acute pain, it shall
18be unlawful for a health insurance issuer to deny coverage of
19the nonopioid prescription drug in favor of an opioid
20prescription drug or to require the patient to try an opioid
21prescription drug prior to providing coverage of the nonopioid
22prescription drug.
23    (c) In establishing and maintaining its drug formulary, a
24health insurance issuer shall ensure that no nonopioid drug

 

 

SB3781- 9 -LRB103 39079 RPS 69217 b

1approved by the United States Food and Drug Administration for
2the treatment or management of pain shall be disadvantaged or
3discouraged, with respect to coverage or cost sharing,
4relative to any opioid or narcotic drug for the treatment or
5management of pain on the health insurance issuer's drug
6formulary, where impermissible disadvantaging or
7discouragement includes, without limitation: imposing more
8restrictive coverage criteria on any such nonopioid drug than
9the least restrictive coverage criteria imposed on an opioid
10or narcotic drug; establishing more restrictive or more
11extensive utilization controls, including, but not limited to,
12more restrictive or more extensive prior authorization or step
13therapy requirements, for such nonopioid drug than the least
14restrictive or extensive utilization controls applicable to
15any such opioid or narcotic drug; or, if the health insurance
16issuer maintains a drug formulary grouped into tiers for the
17purposes of determining cost sharing, placing any such
18nonopioid drug on a tier that requires a cost-sharing
19responsibility that exceeds the lowest cost-sharing
20responsibility required for any opioid or narcotic drug on the
21drug formulary.
22    This subsection applies to a nonopioid drug immediately
23upon its approval by the United States Food and Drug
24Administration for the treatment or management of pain.
 
25    Section 105. The Illinois Public Aid Code is amended by

 

 

SB3781- 10 -LRB103 39079 RPS 69217 b

1adding Section 5-55 as follows:
 
2    (305 ILCS 5/5-55 new)
3    Sec. 5-55. Coverage for nonopioid medications; pain relief
4parity.
5    (a) Required coverage for nonopioid medications.
6Notwithstanding any provision of law to the contrary, whenever
7a licensed health care practitioner prescribes a nonopioid
8medication for the treatment of acute pain, neither the
9Department nor a managed care organization contracted with the
10Department shall deny coverage of the nonopioid prescription
11drug in favor of an opioid prescription drug or require a
12patient to try an opioid prescription drug prior to providing
13coverage of the nonopioid prescription drug.
14    (b) Pain relief parity. In establishing and maintaining
15the Illinois Medicaid Preferred Drug List, the Department
16shall ensure that no nonopioid drug approved by the U.S. Food
17and Drug Administration for the treatment or management of
18pain shall be disadvantaged or discouraged with respect to
19coverage relative to any opioid or narcotic drug for the
20treatment or management of pain on the Illinois Medicaid
21Preferred Drug List, where impermissible disadvantaging or
22discouragement includes, without limitation: designating any
23such nonopioid drug as a nonpreferred drug if any opioid or
24narcotic drug is designated as a preferred drug; or
25establishing more restrictive or more extensive utilization

 

 

SB3781- 11 -LRB103 39079 RPS 69217 b

1controls, including, but not limited to, more restrictive or
2more extensive prior authorization or step therapy
3requirements, for such nonopioid drug than the least
4restrictive or extensive utilization controls applicable to
5any such opioid or narcotic drug. This subsection applies to a
6nonopioid drug immediately upon its approval by the U.S. Food
7and Drug Administration for the treatment or management of
8pain, regardless of whether such drug has been reviewed by the
9Department for inclusion on the Illinois Medicaid Preferred
10Drug List. This subsection also applies to drugs provided
11under a contract between the Department and a managed care
12organization.