97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5196

 

Introduced 2/8/2012, by Rep. Daniel Biss

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Electronic Prescribing Act. Provides that beginning August 1, 2014, a drug prior authorization request must be accessible to a health care provider with the provider's electronic prescribing software system and must be accepted electronically, through a secure electronic transmission, by the payer, by the insurance company, or by the pharmacy benefit manager responsible for implementing or adjudicating or for implementing and adjudicating the authorization or denial of the prior authorization request. Provides that beginning August 1, 2014, electronic transmission devices used to communicate a prescription to a pharmacist may not use any means or permit any other person to use any means, including advertising, commercial messaging, and pop-up advertisements, to influence or attempt to influence through economic incentives the prescribing decision of a prescribing practitioner at the point of care. Creates the Electronic Prescribing Study Committee to study certain aspects of optimizing electronic prescribing systems, including, how to ensure that the prescribing decisions of practitioners at the point of care are focused on patient safety and quality outcomes, and that attempts to influence those decisions, through economic incentives or otherwise, are kept to a minimum. Contains provisions concerning Committee policies; Committee hearings; the Committee's composition; compensation; and reporting requirements. Effective July 1, 2012.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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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
5Electronic Prescribing Act.
 
6    Section 5. Drug prior authorization requests. Beginning
7August 1, 2014, a drug prior authorization request must be
8accessible to a health care provider with the provider's
9electronic prescribing software system and must be accepted
10electronically, through a secure electronic transmission, by
11the payer, by the insurance company, or by the pharmacy benefit
12manager responsible for implementing or adjudicating or for
13implementing and adjudicating the authorization or denial of
14the prior authorization request. For purposes of this Section,
15a facsimile is not an electronic transmission.
 
16    Section 10. Electronic transmission devices. Beginning
17August 1, 2014, electronic transmission devices used to
18communicate a prescription to a pharmacist may not use any
19means or permit any other person to use any means, including
20advertising, commercial messaging, and pop-up advertisements,
21to influence or attempt to influence through economic
22incentives the prescribing decision of a prescribing

 

 

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1practitioner at the point of care. Such means may not be
2triggered by or be in specific response to the input,
3selection, or act of a prescribing practitioner or the
4prescribing practitioner's staff in prescribing a certain
5pharmaceutical or directing a patient to a certain pharmacy.
6Any electronic communication sent to the prescriber, including
7advertising, commercial messaging, or pop-up advertisements,
8must be consistent with the product label, supported by
9scientific evidence, and meet the federal Food and Drug
10Administration requirements for advertising pharmaceutical
11products.
 
12    Section 15. Electronic prescribing software. Electronic
13prescribing software may show information regarding a payer's
14formulary if the software is not designed to preclude or make
15more difficult the act of a prescribing practitioner or patient
16selecting any particular pharmacy or pharmaceutical.
 
17    Section 20. Standardized drug prior authorization request
18transactions; outline. Within 6 months after the effective date
19of this Act, the Electronic Prescribing Study Committee created
20in Section 25 of this Act shall establish an outline on how
21best to standardize drug prior authorization request
22transactions between providers and the payers, insurance
23companies, and pharmacy benefit managers responsible for
24adjudicating the authorization or denial of the prescription

 

 

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1request. The outline must be designed with the goal of
2maximizing administrative simplification and efficiency in
3preparation for electronic transmissions and alignment with
4standards that are or will potentially be used nationally. By
5June 30, 2013, the Electronic Prescribing Study Committee shall
6provide a report to the President of the Senate, the Speaker of
7the House of Representatives, the Secretary of the Senate, the
8Clerk of the House, the Governor, and the Director of the State
9Library regarding the outline on how best to standardize drug
10prior authorization request transactions.
 
11    Section 25. Electronic Prescribing Study Committee. The
12Electronic Prescribing Study Committee is created to study the
13following aspects of optimizing electronic prescribing
14systems: (i) how best to develop a neutral platform for the
15electronic transmission of health data including, but not
16limited to, medication history, formulary status, and other
17patient information health professionals typically access when
18prescribing medication and other interventions; (ii) how to
19ensure that the prescribing decisions of practitioners at the
20point of care are focused on patient safety and quality
21outcomes, and that attempts to influence those decisions,
22through economic incentives or otherwise, are kept to a
23minimum; (iii) how to ensure that messages in electronic
24prescribing systems are substantially supported by scientific
25evidence, are accurate, up-to-date, and fact-based, and

 

 

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1include a fair and balanced presentation of risks and benefits
2and support for better clinical decision-making, such as alerts
3to adverse events and access to formulary information; and (iv)
4how to establish a process to provide electronic prior
5authorization request and approval transactions between
6providers and group purchasers.
 
7    Section 30. Committee policies. The Committee must develop
8and recommend policies that (i) seek to limit marketing in
9electronic health record systems, (ii) seek to encourage the
10provision of evidence-based information at the point of care,
11and (iii) standardize prior authorization to maximize
12administrative simplification and efficiency. The Committee
13shall recommend a universal prior authorization form to be made
14available for electronic use.
 
15    Section 35. Hearings. The Committee may meet and hold
16hearings at the places it designates during the sessions or
17recesses of the General Assembly, and the Committee shall
18report its findings and any recommendations for proposed
19legislation to the President of the Senate, the Speaker of the
20House of Representatives, the Secretary of the Senate, the
21Clerk of the House, the Governor, and the Director of the State
22Library on or before January 1, 2013.
 
23    Section 40. Committee composition. The Committee shall

 

 

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1consist of the following members: the Governor's Senior Health
2Policy Advisor and Chief Information Officer; 2 members of the
3Senate, one appointed by the President of the Senate and the
4other by the Minority Leader of the Senate; 2 members of the
5House of Representatives, one appointed by the Speaker of the
6House of Representatives and the other by the House Minority
7Leader; a representative of the Department of Healthcare and
8Family Services designated by the Director; a representative of
9the Pharmaceutical Research and Manufacturers of America
10(PhRMA) appointed by the Governor; a representative of the
11Illinois Hospital Association appointed by the Governor; a
12representative of the Illinois Medical Society appointed by the
13Governor; a representative of the Illinois Pharmacy
14Association appointed by the Governor; and 2 patient advocates
15appointed by the Governor.
 
16    Section 45. Compensation; staff support. The members of the
17Committee shall serve without compensation, but shall be
18reimbursed for necessary expenses incurred in the performance
19of their duties and within the limits of funds available to the
20Committee. The Committee shall be entitled to call to its
21assistance and avail itself of the services of the employees of
22any State, county, or municipal department, board, bureau,
23commission, or agency as it may require and as may be available
24to it for its purposes. The Department of Healthcare and Family
25Services shall provide staff support to the Committee.
 

 

 

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1    Section 99. Effective date. This Act takes effect July 1,
22012.