Bill Text: IL SB1636 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: 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".

Spectrum: Partisan Bill (Democrat 9-0)

Status: (Introduced) 2024-03-13 - Added as Chief Co-Sponsor Sen. Karina Villa [SB1636 Detail]

Download: Illinois-2023-SB1636-Introduced.html

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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
SB1636 LRB103 28601 KTG 54982 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
adding Section 5-5.12f as follows:
(305 ILCS 5/5-5.12f new)
Sec. 5-5.12f. Prescription drugs for mental illness; no
utilization or prior approval mandates.
(a) Notwithstanding any other provision of this Code to
the contrary, except as otherwise provided in subsection (b),
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.
(b) The following shall be permitted for prescription
drugs covered under this Section:
(1) clinically appropriate drug utilization review
(DUR) edits, including, but not limited to, drug-to-drug,

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

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