SB 1465

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that prior approval by the Department of Healthcare and Family Services to administer to a recipient of medical assistance any interferon-free therapy for the treatment of the hepatitis C virus shall be limited to certain criteria, including that: (i) the recipient must be 18 years of age; (ii) the recipient must have a diagnosis of chronic hepatitis C infection, genotype 1, 2, 3, or 4, confirmed by stage 2 fibrosis; (iii) the recipient must not have end stage renal disease requiring dialysis; and (iv) the recipient may not have abused a controlled substance within the past 6 months. Provides that the Department may not use certain criteria as a basis for requiring prior approval to administer to a recipient of medical assistance any interferon-free therapy for the treatment of the hepatitis C virus, including: (a) any evidence or known diagnosis of malignancy of any body organ; (b) the recipient's mental capacity or any determination related to the recipient's ability to make appropriate decisions about the interferon-free therapy treatment or to comply with related instructions; and (c) the fact that the recipient was previously administered an interferon-free therapy for the treatment of the hepatitis C virus. Contains provisions concerning persons authorized to prescribe an interferon-free therapy for the treatment of the hepatitis C virus to a recipient of medical assistance; the submission of lab results; an appeals process; and payments to managed care entities for any interferon-free therapy for the treatment of the hepatitis C virus that is prescribed to a recipient of medical assistance. Effective immediately.