IL SB1465

Adds Section 5-5.12b to the Illinois Public Aid Code establishing prior approval criteria for interferon-free hepatitis C therapy for medical assistance recipients.

Requires recipients to be at least 18 years old, have chronic hepatitis C (genotype 1-4) confirmed by stage 2 fibrosis, have sufficient kidney function, and have no previous denials for interferon-free therapy.

Prohibits the Department from using pregnancy, mental capacity assessments, malignancy diagnosis, chemotherapy/radiation therapy history, or prior interferon-free therapy as bases for denial.

Restricts prescribers to gastroenterologists, infectious disease specialists, or physicians with written consultation from board-certified specialists in relevant fields.

Requires prescribers to submit lab results before treatment begins, at end of therapy, and 12 weeks after treatment, and establishes an appeals process for recipients who fail to meet criteria or test positive for drugs within 15 days of approval request.

Mandates the Department pay managed care entities a monthly non-capitated rate for interferon-free hepatitis C therapy rather than including it in capitated payments.