Bill Text: IL HB5355 | 2023-2024 | 103rd General Assembly | Engrossed

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Bill Title: 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.

Spectrum: Slight Partisan Bill (Democrat 4-2)

Status: (Engrossed) 2024-04-19 - Referred to Assignments [HB5355 Detail]

Download: Illinois-2023-HB5355-Engrossed.html

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HB5355 Engrossed LRB103 37186 RPS 67305 b
AN ACT concerning health.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Department of Public Health Powers and
Duties Law of the Civil Administrative Code of Illinois is
amended by adding Section 2310-730 as follows:
(20 ILCS 2310/2310-730 new)
Sec. 2310-730. Nonopioid alternatives pamphlet. The
Department of Public Health shall 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. The pamphlet shall,
at a minimum, conform with the most current CDC Clinical
Practice Guideline for Prescribing Opioids for Pain published
by the Centers for Disease Control and Prevention and shall
include:
(1) information on available nonopioid alternatives
for the treatment of pain, including available nonopioid
medicinal drugs or drug products and nonpharmacological
therapies; and
(2) the advantages and disadvantages of the use of
nonopioid alternatives.

HB5355 Engrossed - 2 - LRB103 37186 RPS 67305 b
Section 10. The Illinois Insurance Code is amended by
adding Section 370c.3 as follows:
(215 ILCS 5/370c.3 new)
Sec. 370c.3. Coverage for nonopioid medications; pain
relief parity.
(a) In this Section, "health insurance issuer" has the
meaning set forth in Section 5 of the Illinois Health
Insurance Portability and Accountability Act.
(b) Notwithstanding any provision of law to the contrary,
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 prior to providing coverage of the nonopioid
prescription drug.
(c) In establishing and maintaining its drug formulary, a
health insurance issuer shall ensure that no nonopioid drug
approved by the United States 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 on the health insurance issuer's drug
formulary, where impermissible disadvantaging or
discouragement includes, without limitation: imposing more

HB5355 Engrossed - 3 - LRB103 37186 RPS 67305 b
restrictive coverage criteria on any such nonopioid drug than
the least restrictive coverage criteria imposed on an opioid
or narcotic drug; establishing more restrictive or more
extensive utilization controls, including, but not limited to,
more restrictive or more extensive prior authorization or step
therapy requirements, for such nonopioid drug than the least
restrictive or extensive utilization controls applicable to
any such opioid or narcotic drug; or, if the health insurance
issuer maintains a drug formulary grouped into tiers for the
purposes of determining cost sharing, placing any such
nonopioid drug on a tier that requires a cost-sharing
responsibility that exceeds the lowest cost-sharing
responsibility required for any opioid or narcotic drug on the
drug formulary. This subsection does not preclude opioid drugs
from being preferred over other opioid drugs or nonopioid
drugs from being preferred over other nonopioid drugs.
Section 15. The Illinois Public Aid Code is amended by
adding Section 5-55 as follows:
(305 ILCS 5/5-55 new)
Sec. 5-55. Coverage for nonopioid medications; pain relief
parity.
(a) Required coverage for nonopioid medications.
Notwithstanding any provision of law to the contrary, whenever
a licensed health care practitioner prescribes a nonopioid

HB5355 Engrossed - 4 - LRB103 37186 RPS 67305 b
medication for the treatment of acute pain, neither the
Department nor a managed care organization contracted with the
Department 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.
(b) Pain relief parity. In establishing and maintaining
the Illinois Medicaid Preferred Drug List, the Department
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.