Bill Text: IL SB3781 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-02-09 - Referred to Assignments [SB3781 Detail]

Download: Illinois-2023-SB3781-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3781 Introduced 2/9/2024, by Sen. Karina Villa 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.
LRB103 39079 RPS 69217 b
A BILL FOR
SB3781 LRB103 39079 RPS 69217 b
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

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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

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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:

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(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,

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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.

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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

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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

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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

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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

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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

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