HB4559 93RD GENERAL ASSEMBLY

LRB093 15245 DRJ 40843 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4559

Introduced 02/03/04, by William Delgado

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.12

from Ch. 23, par. 5-5.12

Amends the Illinois Public Aid Code. In provisions concerning pharmacy payments under the Medicaid program, provides that the Department of Public Aid may not impose prior approval requirements for antidepressants or other drugs used in treating serious mental illnesses (deletes the provision allowing imposition of such requirements after conducting an impact study). Requires continuous access to medications. Makes other changes, and makes the provisions concerning prior approval inoperative after December 31, 2006. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by changing Section 5-5.12 as follows:

(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)

Sec. 5-5.12. Pharmacy payments.

(a) Every request submitted by a pharmacy for reimbursement under this Article for prescription drugs provided to a recipient of aid under this Article shall include the name of the prescriber or an acceptable identification number as established by the Department.

(b) Pharmacies providing prescription drugs under this Article shall be reimbursed at a rate which shall include a professional dispensing fee as determined by the Illinois Department, plus the current acquisition cost of the prescription drug dispensed. The Illinois Department shall update its information on the acquisition costs of all prescription drugs no less frequently than every 30 days. However, the Illinois Department may set the rate of reimbursement for the acquisition cost, by rule, at a percentage of the current average wholesale acquisition cost.

(c) Reimbursement under this Article for prescription drugs shall be limited to reimbursement for 4 brand-name prescription drugs per patient per month. This subsection applies only if (i) the brand-name drug was not prescribed for an acute or urgent condition, (ii) the brand-name drug was not prescribed for Alzheimer's disease, arthritis, diabetes, HIV/AIDS, a mental health condition, or respiratory disease, and (iii) a therapeutically equivalent generic medication has been approved by the federal Food and Drug Administration.

(d) The Department shall not impose requirements for prior approval based on a preferred drug list for anti-retroviral, anti-hemophilic factor concentrates, or any atypical antipsychotics, conventional antipsychotics, or anticonvulsants, or antidepressants used for the treatment of serious mental illnesses until 30 days after it has conducted a study of the impact of such requirements on patient care and submitted a report to the Speaker of the House of Representatives and the President of the Senate. The Department shall adopt policies and implement procedures that ensure continuous access to medications 24 hours per day, 7 days per week. In an emergency situation, when prior approval or an edit override is not available, a pharmacy may dispense, and the Department shall pay for, up to a 72-hour supply of a drug prescribed to an eligible recipient for a mental illness. Nothing in this Section shall be construed as preventing the Department from implementing other restrictions to ensure the appropriate use of medications described in this subsection by persons with a serious mental illness, as supported by evidence-based medicine.

This subsection (d) is inoperative after December 31, 2006.

(Source: P.A. 92-597, eff. 6-28-02; 92-825, eff. 8-21-02; 93-106, eff. 7-8-03.)

Section 99. Effective date. This Act takes effect upon becoming law.