97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB0753

 

Introduced 01/31/11, by Rep. Michael J. Madigan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.12  from Ch. 23, par. 5-5.12

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning pharmacy payments under the Medicaid program.


LRB097 03581 KTG 43618 b

 

 

A BILL FOR

 

HB0753LRB097 03581 KTG 43618 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 5-5.12 as follows:
 
6    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
7    Sec. 5-5.12. Pharmacy payments.
8    (a) Every request submitted by a pharmacy for reimbursement
9under this Article for prescription drugs provided to a
10recipient of aid under this Article shall include the the name
11of the prescriber or an acceptable identification number as
12established by the Department.
13    (b) Pharmacies providing prescription drugs under this
14Article shall be reimbursed at a rate which shall include a
15professional dispensing fee as determined by the Illinois
16Department, plus the current acquisition cost of the
17prescription drug dispensed. The Illinois Department shall
18update its information on the acquisition costs of all
19prescription drugs no less frequently than every 30 days.
20However, the Illinois Department may set the rate of
21reimbursement for the acquisition cost, by rule, at a
22percentage of the current average wholesale acquisition cost.
23    (c) (Blank).

 

 

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1    (d) The Department shall not impose requirements for prior
2approval based on a preferred drug list for anti-retroviral,
3anti-hemophilic factor concentrates, or any atypical
4antipsychotics, conventional antipsychotics, or
5anticonvulsants used for the treatment of serious mental
6illnesses until 30 days after it has conducted a study of the
7impact of such requirements on patient care and submitted a
8report to the Speaker of the House of Representatives and the
9President of the Senate.
10    (e) When making determinations as to which drugs shall be
11on a prior approval list, the Department shall include as part
12of the analysis for this determination, the degree to which a
13drug may affect individuals in different ways based on factors
14including the gender of the person taking the medication.
15    (f) (e) The Department shall cooperate with the Department
16of Public Health and the Department of Human Services Division
17of Mental Health in identifying psychotropic medications that,
18when given in a particular form, manner, duration, or frequency
19(including "as needed") in a dosage, or in conjunction with
20other psychotropic medications to a nursing home resident, may
21constitute a chemical restraint or an "unnecessary drug" as
22defined by the Nursing Home Care Act or Titles XVIII and XIX of
23the Social Security Act and the implementing rules and
24regulations. The Department shall require prior approval for
25any such medication prescribed for a nursing home resident that
26appears to be a chemical restraint or an unnecessary drug. The

 

 

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1Department shall consult with the Department of Human Services
2Division of Mental Health in developing a protocol and criteria
3for deciding whether to grant such prior approval.
4(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
5revised 9-2-10.)