HB5355 103RD GENERAL ASSEMBLY

LRB103 37186 RPS 67305 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB5355

Introduced 2/9/2024, by Rep. Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

New Act
215 ILCS 5/370c.3 new
305 ILCS 5/5-55 new

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.

A BILL FOR

AN ACT concerning health.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Nonopioid Alternatives for Pain Act.

Section 3. Findings. The General Assembly finds that every competent adult has the fundamental right of self-determination regarding decisions pertaining to that adult's own health, including the right to refuse an opioid drug.

Section 5. Definitions. As used in this Act:

"Department" means the Department of Public Health.

"Emergency medical services personnel" has the meaning given to that term in Section 3.5 of the Emergency Medical Services (EMS) Systems Act.

"Health care practitioner" means a person licensed or registered by the Department of Financial and Professional Regulation under the following Acts: the Medical Practice Act of 1987, the Nurse Practice Act, the Clinical Psychologist Licensing Act, the Illinois Optometric Practice Act of 1987, the Illinois Physical Therapy Act, the Pharmacy Practice Act, the Physician Assistant Practice Act of 1987, the Clinical Social Work and Social Work Practice Act, the Nursing Home Administrators Licensing and Disciplinary Act, the Illinois Occupational Therapy Practice Act, the Podiatric Medical Practice Act of 1987, the Respiratory Care Practice Act, the Professional Counselor and Clinical Professional Counselor Licensing and Practice Act, the Illinois Speech-Language Pathology and Audiology Practice Act, the Illinois Dental Practice Act, the Illinois Dental Practice Act, or the Behavior Analyst Licensing Act.

"Nonopioid directive form" means the form developed under Section 20.

"Prescriber" has the meaning given to that term in subsection (mm) of Section 102 of the Illinois Controlled Substances Act.

Section 10. 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.

Section 15. Prescription of opioids.

(a) A health care practitioner shall exercise professional judgment in selecting appropriate treatment modalities for acute nonoperative, acute perioperative, subacute, or chronic pain in accordance with the most current CDC Clinical Practice Guideline for Prescribing Opioids for Pain published by the Centers for Disease Control and Prevention, including the use of nonopioid alternatives whenever reasonable, clinically appropriate, and evidence-based alternatives exist.

(b) The health care practitioner shall consider prescribing nonopioids as the first line of pain control in patients, unless the prescription is not clinically appropriate, in accordance with subsection (a).

(c) Except when a patient is receiving care in a hospital critical care unit or emergency department or a patient is receiving hospice services under Hospice Program Licensing Act, before providing care requiring the administration of anesthesia involving the use of an opioid drug, or prescribing or ordering an opioid drug for the treatment of pain, a health care practitioner who prescribes or orders an opioid drug must do all of the following:

(1) Inform the patient or the patient's representative of available nonopioid alternatives for the treatment of pain, which may include available nonopioid medicinal drugs or drug products, interventional procedures or treatments, acupuncture, chiropractic treatments, massage therapy, physical therapy, occupational therapy, or any other appropriate therapy as determined by the health care practitioner.

(2) Discuss with the patient or the patient's representative the advantages and disadvantages of the use of nonopioid alternatives and whether the patient is at a high risk of, or has a history of, controlled substance abuse or misuse and the patient's personal preferences.

(3) Provide the patient or the patient's representative, electronically or in printed form, with the educational pamphlet described in Section 10.

(4) Document in the patient's record that nonopioid alternatives were considered and discussed with the patient or the patient's representative and, to the extent that the health care practitioner prescribes or orders an opioid for the treatment of pain, document the reasons for such a prescription or order.

Section 20. Nonopioid directive form. The Department shall develop a nonopioid directive form indicating to health care practitioners and emergency medical services personnel that, except as otherwise provided in Section 30 or in rules adopted by the Department, a patient who has executed the form or who has had a form executed on the patient's behalf must not be administered an opioid or offered a prescription for an opioid. The Department shall include on the nonopioid directive form instructions on how the form may be revoked and any other information that the Department considers relevant. The Department shall make the form available to the public on the Department's website.

Section 25. Nonopioid directive form; execution. A patient may execute a nonopioid directive form on his or her own behalf. A guardian or patient advocate of a patient may execute a nonopioid directive form on behalf of the patient. If a nonopioid directive form is executed by or on behalf of a patient and is presented to a health care practitioner, the health care practitioner shall obtain a copy of the form and include the copy in the patient's medical record. A patient may revoke a nonopioid directive form executed by himself or herself at any time and in any manner by which he or she is able to communicate his or her intent to revoke the form. A patient advocate or guardian may revoke a nonopioid directive form on behalf of a patient at any time by issuing the revocation in writing and providing notice of the revocation to the patient's health professional or his or her delegate.

Section 30. Administration of an opioid to a patient who has executed a nonopioid directive form. A prescriber who holds a controlled substances license or a health care practitioner who is a practical nurse or registered professional nurse and is acting on the order of the prescriber may administer an opioid to a patient who has executed a nonopioid directive form or who has had a nonopioid directive form executed on his or her behalf if the patient is being treated at a hospital or in a setting outside of a hospital in the case of an emergency and, in the prescriber's professional opinion, the administration of the opioid is medically necessary to treat the patient. If an opioid is administered under this Section, the prescriber shall ensure that the patient is provided with information on substance use disorder services.

Section 35. Limitation of liability. Except as otherwise provided by law, the following are not subject to civil or criminal liability or professional disciplinary action for failing to administer, prescribe, or dispense an opioid, or for the inadvertent administration of an opioid, to a patient who has executed a nonopioid directive form or who has had a nonopioid directive form executed on his or her behalf if the failure to act or the act was done reasonably and in good faith:

(1) A health care practitioner whose scope of practice includes the prescribing, administering, or dispensing of a controlled substance.

(2) A health facility or agency.

(3) An employee of a health care practitioner.

(4) An employee of a health facility or agency.

(5) Emergency medical services personnel.

Section 40. Rulemaking. The Department shall adopt rules to implement this Act. The rules must allow a health care practitioner or health facility or agency to incorporate a nonopioid directive form into an existing patient form or into other documentation used by the health care practitioner or health facility or agency, and the rules must include, but not be limited to, all of the following:

(1) Procedures to record a nonopioid directive form in a medical record, including an electronic medical record.

(2) Procedures to revoke a nonopioid directive form.

(3) Procedures to ensure that the recording, disclosure, or distribution of data relating to a nonopioid directive form or the transmission of a nonopioid directive form complies with State and federal confidentiality and consent laws, rules, and regulations.

(4) Exemptions for administering or prescribing an opioid to a patient who has executed a nonopioid directive form or who has had a nonopioid directive form executed on his or her behalf if the opioid is administered or prescribed to treat the patient for a substance use disorder.

(5) Exemptions for administering or prescribing an opioid to a patient who has executed a nonopioid directive form or who has had a nonopioid directive form executed on his or her behalf if the patient is a hospice patient.

Section 100. 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 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 applies to a nonopioid drug immediately upon its approval by the United States Food and Drug Administration for the treatment or management of pain.

Section 105. 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 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 no nonopioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain shall be disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the Illinois Medicaid Preferred Drug List, where impermissible disadvantaging or discouragement includes, without limitation: designating any such nonopioid drug as a nonpreferred drug if any opioid or narcotic drug is designated as a preferred drug; or 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. This subsection applies to a nonopioid drug immediately upon its approval by the U.S. Food and Drug Administration for the treatment or management of pain, regardless of whether such drug has been reviewed by the Department for inclusion on the Illinois Medicaid Preferred Drug List. This subsection also applies to drugs provided under a contract between the Department and a managed care organization.