Illinois HB 2438: MEDICAID-RX-MENTAL ILLNESS

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104TH GENERAL ASSEMBLY 
State of Illinois 
2025 and 2026
HB2438

Introduced 2/4/2025, by Rep. Maurice A. West, II 

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.12f

 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs on specified FDA-approved prescription drugs for mental illness, provides that the prohibition shall apply if a preferred or non-preferred drug is prescribed to an adult patient to treat a serious mental illness and during the preceding 60 days, the patient who experienced an inadequate response was prescribed and unsuccessfully treated with a 14-day treatment trial of a drug for the same clinical condition that is included on the preferred drug list. Removes provisions conditioning the receipt of prescription drugs without prior authorization on: (i) the patient changing providers while receiving a previously authorized prescription drug; (ii) the patient changing insurance coverage while receiving a previously authorized prescription drug; and (iii) the patient's prescription for a previously authorized drug modifies the dosage, dosage frequency, or both, of the drug as part of the same treatment for which the drug was previously prescribed.

LRB104 04068 KTG 14092 b

A BILL FOR

HB2438LRB104 04068 KTG 14092 b

1 AN ACT concerning public aid.

2 Be it enacted by the People of the State of Illinois, 

3represented in the General Assembly:

4 Section 5. The Illinois Public Aid Code is amended by 

5changing Section 5-5.12f as follows:

6 (305 ILCS 5/5-5.12f)

7 Sec. 5-5.12f. Prescription drugs for mental illness; no 

8utilization or prior appro