103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1636

 

Introduced 2/8/2023, by Sen. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.12f new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for the purpose of removing barriers to the timely treatment of serious mental illnesses, prior authorization mandates and utilization management controls shall not be imposed under the fee-for-service and managed care medical assistance programs on any FDA-approved prescription drug that is recognized by a generally accepted standard medical reference as effective in the treatment of conditions specified in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Provides that the following shall be permitted for prescription drugs covered under the amendatory Act: (i) clinically appropriate drug utilization review (DUR) edits, including, but not limited to, drug-to-drug, drug-age, and drug-dose; (ii) generic drug substitution if a generic drug is available for the prescribed medication in the same dosage and formulation; and (iii) any utilization management control that is necessary for the Department of Healthcare and Family Services to comply with any current consent decrees or federal waivers. Defines "serious mental illness".


LRB103 28601 KTG 54982 b

 

 

A BILL FOR

 

SB1636LRB103 28601 KTG 54982 b

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 5. The Illinois Public Aid Code is amended by
5adding Section 5-5.12f as follows:
 
6    (305 ILCS 5/5-5.12f new)
7    Sec. 5-5.12f. Prescription drugs for mental illness; no
8utilization or prior approval mandates.
9    (a) Notwithstanding any other provision of this Code to
10the contrary, except as otherwise provided in subsection (b),
11for the purpose of removing barriers to the timely treatment
12of serious mental illnesses, prior authorization mandates and
13utilization management controls shall not be imposed under the
14fee-for-service and managed care medical assistance programs
15on any FDA-approved prescription drug that is recognized by a
16generally accepted standard medical reference as effective in
17the treatment of conditions specified in the most recent
18Diagnostic and Statistical Manual of Mental Disorders
19published by the American Psychiatric Association.
20    (b) The following shall be permitted for prescription
21drugs covered under this Section:
22        (1) clinically appropriate drug utilization review
23    (DUR) edits, including, but not limited to, drug-to-drug,

 

 

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1    drug-age, and drug-dose;
2        (2) generic drug substitution if a generic drug is
3    available for the prescribed medication in the same dosage
4    and formulation; and
5        (3) any utilization management control that is
6    necessary for the Department to comply with any current
7    consent decrees or federal waivers.
8    (c) As used in this Section, "serious mental illness"
9means any one or more of the following diagnoses and
10International Classification of Diseases, Tenth Revision,
11Clinical Modification (ICD-10-CM) codes listed by the
12Department of Human Services' Division of Mental Health, as
13amended, on its official website:
14        (1) Delusional Disorder (F22)
15        (2) Brief Psychotic Disorder (F23)
16        (3) Schizophreniform Disorder (F20.81)
17        (4) Schizophrenia (F20.9)
18        (5) Schizoaffective Disorder (F25.x)
19        (6) Catatonia Associated with Another Mental Disorder
20    (Catatonia Specifier) (F06.1)
21        (7) Other Specified Schizophrenia Spectrum and Other
22    Psychotic Disorder (F28)
23        (8) Unspecified Schizophrenia Spectrum and Other
24    Psychotic Disorder (F29)
25        (9) Bipolar I Disorder (F31.xx)
26        (10) Bipolar II Disorder (F31.81)

 

 

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1        (11) Cyclothymic Disorder (F34.0)
2        (12) Unspecified Bipolar and Related Disorder (F31.9)
3        (13) Disruptive Mood Dysregulation Disorder (F34.8)
4        (14) Major Depressive Disorder Single episode (F32.xx)
5        (15) Major Depressive Disorder, Recurrent episode
6    (F33.xx)
7        (16) Obsessive-Compulsive Disorder (F42)
8        (17) Posttraumatic Stress Disorder (F43.10)
9        (18) Anorexia Nervosa (F50.0x)
10        (19) Bulimia Nervosa (F50.2)
11        (20) Postpartum Depression (F53.0)
12        (21) Puerperal Psychosis (F53.1)
13        (22) Factitious Disorder Imposed on Another (F68.A)