Bill > HB4034

This bill amends the Illinois Public Aid Code to modify regulations around prescription drugs for mental illness in the state's Medicaid programs. Specifically, the bill aims to reduce barriers to treatment by prohibiting prior authorization mandates and utilization management controls for FDA-approved prescription drugs used to treat serious mental illnesses. The bill allows these restrictions to be lifted if an adult patient has experienced an inadequate response to a 14-day treatment trial of a preferred drug within the past 60 days, and meets additional conditions such as changing healthcare providers or insurance coverage, or requiring a modification to an existing prescription. The bill defines "serious mental illness" by listing 22 specific mental health diagnoses with their corresponding medical codes, including conditions like schizophrenia, bipolar disorder, major depressive disorder, and posttraumatic stress disorder. While removing many administrative barriers, the bill still permits certain safety measures like drug utilization review edits, generic drug substitution, and controls necessary to comply with federal requirements. The overall goal is to ensure patients with serious mental illnesses can more easily access and maintain their prescribed medications without unnecessary administrative hurdles.

https://www.ilga.gov/legislation/BillStatus.asp?DocNum=4034&GAID=18&DocTypeID=HB&SessionID=114&GA=104