94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB5272


 
Introduced 01/25/06, by Rep. Kathleen A. Ryg - Patricia R. Bellock
 
SYNOPSIS AS INTRODUCED:
 		














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







    Amends the Illinois Public Aid Code. Provides that reimbursement under the Medicaid program for prescription drugs shall be limited to
reimbursement for 4 brand-name prescription drugs per patient per month. Provides that this limitation does not
apply if (i) the brand-name drug was prescribed for an acute or urgent condition, (ii) the brand-name
drug was prescribed for Alzheimer's disease, arthritis, diabetes, HIV/AIDS, a mental health
condition, hemophilia, or respiratory diseases, (iii) the brand-name drug was prescribed for less than
30 days for acute infections, and (iv) a therapeutically equivalent generic medication has not been
approved by the federal Food and Drug Administration. Effective July 1, 2006.

















LRB094 18104 DRJ 53409 b

















FISCAL NOTE ACT MAY APPLY
















 


 


A BILL FOR









 











HB5272

LRB094 18104 DRJ 53409 b






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    AN ACT concerning public aid.

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


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



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



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    Sec. 5-5.12. Pharmacy payments. 

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

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    (b) Pharmacies providing prescription drugs under
this 
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Article shall be reimbursed at a rate which shall include
a 
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professional dispensing fee as determined by the Illinois

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Department, plus the current acquisition cost of the 
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prescription
drug dispensed. The Illinois Department shall 
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update its
information on the acquisition costs of all 
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prescription drugs
no less frequently than every 30 days. 
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However, the Illinois
Department may set the rate of 
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reimbursement for the acquisition
cost, by rule, at a 
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percentage of the current average wholesale
acquisition cost.

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    (c) Reimbursement under this Article for prescription 
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drugs shall be limited to
reimbursement for 4 brand-name 
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prescription drugs per patient per month. This subsection does 
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not
apply if (i) the brand-name drug was prescribed for an 
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acute or urgent condition, (ii) the brand-name
drug was 
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prescribed for Alzheimer's disease, arthritis, diabetes, 
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HIV/AIDS, a mental health
condition, hemophilia, or 
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respiratory diseases, (iii) the brand-name drug was prescribed 
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for less than
30 days for acute infections, and (iv) a 
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therapeutically equivalent generic medication has not been

 


 






HB5272
- 2 -
LRB094 18104 DRJ 53409 b




1
approved by the federal Food and Drug Administration.
(Blank).

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    (d) The Department shall not impose requirements for prior 
3
approval
based on a preferred drug list for anti-retroviral, 
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anti-hemophilic factor
concentrates,
or
any atypical 
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antipsychotics, conventional antipsychotics,
or 
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anticonvulsants used for the treatment of serious mental

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illnesses
until 30 days after it has conducted a study of the 
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impact of such
requirements on patient care and submitted a 
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report to the Speaker of the
House of Representatives and the 
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President of the Senate.

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(Source: P.A. 93-106, eff. 7-8-03; 94-48, eff. 7-1-05.)

 

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    Section 99. Effective date. This Act takes effect July 1, 
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2006.