Illinois General Assembly - Bill Status for HB5355

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.

Removes all of the provisions of the Nonopioid Alternatives for Pain Act except for the provisions requiring the Department of Public Health to develop and publish on its website an educational pamphlet regarding the use of nonopioid alternatives for the treatment of acute nonoperative, acute perioperative, subacute, or chronic pain. Moves those provisions to the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. In provisions amending the Illinois Insurance Code and the Illinois Public Aid Code, removes language providing that the provisions apply to a nonopioid drug immediately upon its approval by the U.S. Food and Drug Administration. Provides that the Department of Healthcare and Family Services shall ensure that nonopioid drugs preferred on the Department's preferred drug list, and approved by the U.S. Food and Drug Administration, for the treatment or management of pain shall not be disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain (instead of with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the Illinois Medicaid Preferred Drug List, where impermissible disadvantaging or discouragement includes, without limitation: designating any such nonopioid drug as a nonpreferred drug if any opioid or narcotic drug is designated as a preferred drug; or establishing more restrictive or more extensive utilization). Removes language concerning the applicability of the provisions to drugs provided under a contract between the Department and a managed care organization. Provides that the changes to the Illinois Insurance Code and the Illinois Public Aid Code are effective January 1, 2026.

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