Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1238 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	SB1238 EngrossedLRB104 09624 BDA 19689 b SB1238 Engrossed LRB104 09624 BDA 19689 b
2		-	SB1238 Engrossed LRB104 09624 BDA 19689 b
	1	+	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 new215 ILCS 5/370c.3 new305 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. LRB104 09624 BDA 19689 b A BILL FOR 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 new215 ILCS 5/370c.3 new305 ILCS 5/5-58 new 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. LRB104 09624 BDA 19689 b LRB104 09624 BDA 19689 b A BILL FOR
	2	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1238 Introduced 1/24/2025, by Sen. Karina Villa SYNOPSIS AS INTRODUCED:
	3	+	20 ILCS 2310/2310-735 new215 ILCS 5/370c.3 new305 ILCS 5/5-58 new 20 ILCS 2310/2310-735 new 215 ILCS 5/370c.3 new 305 ILCS 5/5-58 new
	4	+	20 ILCS 2310/2310-735 new
	5	+	215 ILCS 5/370c.3 new
	6	+	305 ILCS 5/5-58 new
	7	+	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.
	8	+	LRB104 09624 BDA 19689 b LRB104 09624 BDA 19689 b
	9	+	LRB104 09624 BDA 19689 b
	10	+	A BILL FOR
	11	+	SB1238LRB104 09624 BDA 19689 b SB1238 LRB104 09624 BDA 19689 b
	12	+	SB1238 LRB104 09624 BDA 19689 b
3	13		1 AN ACT concerning health.
4	14		2 Be it enacted by the People of the State of Illinois,
5	15		3 represented in the General Assembly:
6	16		4 Section 5. The Department of Public Health Powers and
7	17		5 Duties Law of the Civil Administrative Code of Illinois is
8	18		6 amended by adding Section 2310-735 as follows:
9	19		7 (20 ILCS 2310/2310-735 new)
10	20		8 Sec. 2310-735. Nonopioid alternatives pamphlet. The
11		-	9 Department may develop and publish on its ~~website an~~
12		-	10 educational pamphlet regarding the use of nonopioid
	21	+	9 Department of Public Health may develop and publish on its
	22	+	10 website an educational pamphlet regarding the use of nonopioid
13	23		11 alternatives for the treatment of acute nonoperative, acute
14	24		12 perioperative, subacute, or chronic pain. The pamphlet may
15	25		13 conform with the United States Department of Health and Human
16	26		14 Services' Pain Management Best Practices Inter-Agency Task
17	27		15 Force recommendations and shall include:
18	28		16 (1) information on available nonopioid alternatives
19	29		17 for the treatment of pain, including available nonopioid
20	30		18 medicinal drugs or drug products and nonpharmacological
21	31		19 therapies; and
22	32		20 (2) the advantages and disadvantages of the use of
23	33		21 nonopioid alternatives.
24	34		22 Section 10. The Illinois Insurance Code is amended by
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33		-	1 adding Section 370c.3 as follows:
34		-	2 (215 ILCS 5/370c.3 new)
35		-	3 Sec. 370c.3. Parity for coverage for nonopioid medications
36		-	4 to treat acute pain.
37		-	5 (a) Beginning January 1, 2027, a health insurance issuer
38		-	6 shall develop a plan to provide adequate coverage and access
39		-	7 to a broad spectrum of pain management services, including,
40		-	8 but not limited to, nonopioid, nonnarcotic pain management
41		-	9 services and non-medication pain management services that
42		-	10 serve as alternatives to the prescribing of opioid or narcotic
43		-	11 drugs in accordance with guidelines developed by the
44		-	12 Department of Insurance.
45		-	13 (b) A health insurance issuer shall file the plan required
46		-	14 under subsection (a) with the Department of Insurance and
47		-	15 shall post information about the pain management plan on the
48		-	16 insurer's publicly accessible website.
49		-	17 Section 15. The Illinois Public Aid Code is amended by
50		-	18 adding Section 5-58 as follows:
51		-	19 (305 ILCS 5/5-58 new)
52		-	20 Sec. 5-58. Illinois Medicaid Preferred Drug List;
53		-	21 nonopioid drugs. In establishing and maintaining the Illinois
54		-	22 Medicaid Preferred Drug List as described in Section 5-30.14,
55		-	23 the Department shall ensure that nonopioid drugs on the
	38	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1238 Introduced 1/24/2025, by Sen. Karina Villa SYNOPSIS AS INTRODUCED:
	39	+	20 ILCS 2310/2310-735 new215 ILCS 5/370c.3 new305 ILCS 5/5-58 new 20 ILCS 2310/2310-735 new 215 ILCS 5/370c.3 new 305 ILCS 5/5-58 new
	40	+	20 ILCS 2310/2310-735 new
	41	+	215 ILCS 5/370c.3 new
	42	+	305 ILCS 5/5-58 new
	43	+	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.
	44	+	LRB104 09624 BDA 19689 b LRB104 09624 BDA 19689 b
	45	+	LRB104 09624 BDA 19689 b
	46	+	A BILL FOR
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61		-	SB1238 Engrossed - 2 - LRB104 09624 BDA 19689 b
	52	+	20 ILCS 2310/2310-735 new
	53	+	215 ILCS 5/370c.3 new
	54	+	305 ILCS 5/5-58 new
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66		-	1 Department's preferred drug list, and approved by the U.S.
67		-	2 Food and Drug Administration, for the treatment or management
68		-	3 of pain shall not be disadvantaged or discouraged with respect
69		-	4 to coverage relative to any opioid or narcotic drug for the
70		-	5 treatment or management of acute pain as long as the
71		-	6 Department retains its authority to manage the Preferred Drug
72		-	7 List process pursuant to State or federal law, rules,
73		-	8 regulations, and policies and the Department's authority over
74		-	9 the Preferred Drug List process is not undermined or
75		-	10 compromised.
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	58	+	LRB104 09624 BDA 19689 b
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81		-	SB1238 Engrossed - 3 - LRB104 09624 BDA 19689 b
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	68	+	SB1238 LRB104 09624 BDA 19689 b
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	71	+	SB1238- 2 -LRB104 09624 BDA 19689 b SB1238 - 2 - LRB104 09624 BDA 19689 b
	72	+	SB1238 - 2 - LRB104 09624 BDA 19689 b
	73	+	1 adding Sections 370c.3 as follows:
	74	+	2 (215 ILCS 5/370c.3 new)
	75	+	3 Sec. 370c.3. Coverage for nonopioid medications; pain
	76	+	4 relief parity.
	77	+	5 (a) In this Section, "health insurance issuer" has the
	78	+	6 meaning set forth in Section 5 of the Illinois Health
	79	+	7 Insurance Portability and Accountability Act.
	80	+	8 (b) Notwithstanding any provision of law to the contrary,
	81	+	9 when a licensed health care practitioner prescribes a
	82	+	10 nonopioid medication for the treatment of acute pain, it shall
	83	+	11 be unlawful for a health insurance issuer to deny coverage of
	84	+	12 the nonopioid prescription drug in favor of an opioid
	85	+	13 prescription drug or to require the patient to try an opioid
	86	+	14 prescription drug prior to providing coverage of the nonopioid
	87	+	15 prescription drug.
	88	+	16 (c) In establishing and maintaining its drug formulary, a
	89	+	17 health insurance issuer shall ensure that no nonopioid drug
	90	+	18 approved by the United States Food and Drug Administration for
	91	+	19 the treatment or management of pain shall be disadvantaged or
	92	+	20 discouraged, with respect to coverage or cost sharing,
	93	+	21 relative to any opioid or narcotic drug for the treatment or
	94	+	22 management of pain on the health insurance issuer's drug
	95	+	23 formulary, where impermissible disadvantaging or
	96	+	24 discouragement includes, without limitation: imposing more
	97	+	25 restrictive coverage criteria on any such nonopioid drug than
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	103	+	SB1238 - 2 - LRB104 09624 BDA 19689 b
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	106	+	SB1238- 3 -LRB104 09624 BDA 19689 b SB1238 - 3 - LRB104 09624 BDA 19689 b
	107	+	SB1238 - 3 - LRB104 09624 BDA 19689 b
	108	+	1 the least restrictive coverage criteria imposed on an opioid
	109	+	2 or narcotic drug; establishing more restrictive or more
	110	+	3 extensive utilization controls, including, but not limited to,
	111	+	4 more restrictive or more extensive prior authorization or step
	112	+	5 therapy requirements, for such nonopioid drug than the least
	113	+	6 restrictive or extensive utilization controls applicable to
	114	+	7 any such opioid or narcotic drug; or, if the health insurance
	115	+	8 issuer maintains a drug formulary grouped into tiers for the
	116	+	9 purposes of determining cost sharing, placing any such
	117	+	10 nonopioid drug on a tier that requires a cost-sharing
	118	+	11 responsibility that exceeds the lowest cost-sharing
	119	+	12 responsibility required for any opioid or narcotic drug on the
	120	+	13 drug formulary. This subsection does not preclude opioid drugs
	121	+	14 from being preferred over other opioid drugs or nonopioid
	122	+	15 drugs from being preferred over other nonopioid drugs.
	123	+	16 Section 15. The Illinois Public Aid Code is amended by
	124	+	17 adding Section 5-58 as follows:
	125	+	18 (305 ILCS 5/5-58 new)
	126	+	19 Sec. 5-58. Coverage for nonopioid medications; pain relief
	127	+	20 parity.
	128	+	21 (a) Required coverage for nonopioid medications.
	129	+	22 Notwithstanding any provision of law to the contrary, whenever
	130	+	23 a licensed health care practitioner prescribes a nonopioid
	131	+	24 medication for the treatment of acute pain, neither the
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	137	+	SB1238 - 3 - LRB104 09624 BDA 19689 b
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	140	+	SB1238- 4 -LRB104 09624 BDA 19689 b SB1238 - 4 - LRB104 09624 BDA 19689 b
	141	+	SB1238 - 4 - LRB104 09624 BDA 19689 b
	142	+	1 Department nor a managed care organization contracted with the
	143	+	2 Department shall deny coverage of the nonopioid prescription
	144	+	3 drug in favor of an opioid prescription drug or require a
	145	+	4 patient to try an opioid prescription drug prior to providing
	146	+	5 coverage of the nonopioid prescription drug.
	147	+	6 (b) Pain relief parity. In establishing and maintaining
	148	+	7 the Illinois Medicaid Preferred Drug List, the Department
	149	+	8 shall ensure that nonopioid drugs preferred on the
	150	+	9 Department's preferred drug list, and approved by the U.S.
	151	+	10 Food and Drug Administration, for the treatment or management
	152	+	11 of pain shall not be disadvantaged or discouraged with respect
	153	+	12 to coverage relative to any opioid or narcotic drug for the
	154	+	13 treatment or management of pain.
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	160	+	SB1238 - 4 - LRB104 09624 BDA 19689 b