SB1238 104TH GENERAL ASSEMBLY

LRB104 09624 BDA 19689 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB1238

Introduced 1/24/2025, by Sen. Karina Villa

SYNOPSIS AS INTRODUCED:

20 ILCS 2310/2310-735 new
215 ILCS 5/370c.3 new
305 ILCS 5/5-58 new

Creates the Nonopioid Alternatives for Pain Act. Allows the Department of Public Health to develop and publish on its website a nonopioid alternatives pamphlet, with certain requirements. Prohibits a health insurance issuer to deny coverage of a nonopioid prescription drug in favor of an opioid prescription drug. Amends the Illinois Public Aid Code. Provides that coverage shall not be denied for a nonopioid prescription drug in favor of an opioid prescription drug. Requires that nonopioid drugs preferred on a specific list 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. Effective July 1, 2027.

A BILL FOR

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 2310-735 as follows:

(20 ILCS 2310/2310-735 new)

Sec. 2310-735. Nonopioid alternatives pamphlet. The Department of Public Health may 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 may conform with the United States Department of Health and Human Services' Pain Management Best Practices Inter-Agency Task Force recommendations 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.

Section 10. The Illinois Insurance Code is amended by adding Sections 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 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 5-58 as follows:

(305 ILCS 5/5-58 new)

Sec. 5-58. 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 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.

Section 99. Effective date. This Act takes effect January 1, 2027.