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.


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A BILL FOR

 

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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 1. Findings. The General Assembly finds that:
5        (1) The Department of Human Services identifies
6    persons with a serious mental illness as those individuals
7    who have a diagnosis that meets the diagnostic criteria
8    established in the Diagnostic and Statistical Manual of
9    Mental Disorders, Fifth Edition (DSM-5) and which is the
10    focus of the treatment being provided, such as
11    schizophrenia, schizophreniform disorder,
12    schizo-affective disorder, delusional disorder, shared
13    psychotic disorder, brief psychotic disorder, psychotic
14    disorder, bipolar disorder NOS, cyclothymic disorder,
15    major depression, obsessive-compulsive disorder, anorexia
16    nervosa, and bulimia nervosa.
17        (2) Annually, more than 380,000 emergency department
18    visits in the U.S. involve adults with schizophrenia.
19    According to the National Center for Health Statistics,
20    32.7% of these emergency department visits result in a
21    hospital admission while 16.7% of these visits result in a
22    transfer to a psychiatric hospital.
23        (3) In its July 2021 Statistical Brief #278, the
24    Agency for Healthcare Research and Quality identified

 

 

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1    schizophrenia as the 7th most common diagnosis among
2    adults for hospital readmissions across all insurers in
3    2018.
4        (4) Serious mental illnesses can be effectively
5    treated with medications approved by the federal Food and
6    Drug Administration (FDA).
7        (5) Other states, including Michigan, Indiana, Ohio,
8    Missouri, Texas, Florida, Georgia, Connecticut, Hawaii,
9    Oregon, Arizona, and Maine, have recognized the importance
10    of patient access to FDA-approved medications for the
11    treatment of a serious mental illness and have removed
12    prior authorization barriers to those FDA-approved
13    medications.
14        (6) Illinois has a shortage of mental health
15    providers. FDA-approved medications for the treatment of a
16    serious mental illness should be available to all
17    providers with prescriptive authority in the State,
18    including medical doctors, osteopathic doctors, physicians
19    assistants, and nurse practitioners.
20        (7) The Illinois Medicaid Preferred Drug List already
21    includes FDA-approved medications that do not require
22    prior authorization and that have a safety and
23    tolerability profile equivalent to FDA-approved
24    medications for the treatment of a serious mental illness
25    that do require prior authorization.
26        (8) Annually, this State issues an estimated 60,000

 

 

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1    prescription medications that do not require prior
2    authorization and that have a safety and tolerability
3    profile that is equivalent to FDA-approved medications for
4    the treatment of a serious mental illness that do require
5    prior authorization.
6        (9) As a matter of professional practice, Illinois
7    health care providers who prescribe FDA-approved
8    medications that contain an opioid antagonist first
9    consult the Illinois Prescription Monitoring Program to
10    determine if the patient is being actively prescribed an
11    opioid.
12        (10) The removal of prior authorization requirements
13    for FDA-approved medications for the treatment of a
14    serious mental illness would have no impact on any
15    federally-mandated drug rebates Illinois receives from
16    drug manufactures under the Medicaid Drug Rebate Program.
 
17    Section 5. The Illinois Public Aid Code is amended by
18adding Section 5-5.12f as follows:
 
19    (305 ILCS 5/5-5.12f new)
20    Sec. 5-5.12f. Non-controlled prescription medications to
21treat mental illness.
22    (a) As used in this Section:
23    "DSM-5 criteria" means the diagnostic criteria established
24in the Diagnostic and Statistical Manual of Mental Disorders,

 

 

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1Fifth Edition (DSM-5).
2    "FDA" means the United States Food and Drug
3Administration.
4    (b) Notwithstanding any other provision of this Code to
5the contrary, on and after July 1, 2023, all non-controlled
6FDA-approved prescription medications for the treatment of a
7serious mental illness, as defined by the Department of Human
8Services, shall be covered under the medical assistance
9program for persons otherwise eligible for medical assistance
10who are diagnosed with a mental disorder that meets DSM-5
11criteria and which is the focus of the treatment provided,
12including, but not limited to, schizophrenia, schizo-affective
13disorders, bipolar disorders, or major depression.
14Prescription medications covered under this Section shall not
15be subject to any prior authorization mandate or lifetime
16restriction limit mandate. For any medication covered under
17this Section that contains an opioid antagonist, the
18prescriber shall check the Illinois Prescription Monitoring
19Program to determine if the patient is being actively
20prescribed an opioid. The prescriber of a non-controlled
21FDA-approved prescription medication must be a board-certified
22psychiatrist or a medical professional with prescribing
23authority that routinely treats patients with a serious mental
24illness.
 
25    Section 99. Effective date. This Act takes effect July 1,
262023.