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| | 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 |
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Amends the Illinois Public Aid Code. Makes a technical change in a
Section concerning pharmacy payments under the Medicaid program.
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| | A BILL FOR |
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| | HB0753 | | LRB097 03581 KTG 43618 b |
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| 1 | | AN ACT concerning public aid.
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| 2 | | Be it enacted by the People of the State of Illinois, |
| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Public Aid Code is amended by |
| 5 | | changing Section 5-5.12 as follows:
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| 6 | | (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
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| 7 | | Sec. 5-5.12. Pharmacy payments.
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| 8 | | (a) Every request submitted by a pharmacy for reimbursement |
| 9 | | under this
Article for prescription drugs provided to a |
| 10 | | recipient of aid under this
Article shall include the
the name |
| 11 | | of the prescriber or an acceptable
identification number as |
| 12 | | established by the Department. |
| 13 | | (b) Pharmacies providing prescription drugs under
this |
| 14 | | Article shall be reimbursed at a rate which shall include
a |
| 15 | | professional dispensing fee as determined by the Illinois
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| 16 | | Department, plus the current acquisition cost of the |
| 17 | | prescription
drug dispensed. The Illinois Department shall |
| 18 | | update its
information on the acquisition costs of all |
| 19 | | prescription drugs
no less frequently than every 30 days. |
| 20 | | However, the Illinois
Department may set the rate of |
| 21 | | reimbursement for the acquisition
cost, by rule, at a |
| 22 | | percentage of the current average wholesale
acquisition cost.
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| 23 | | (c) (Blank).
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| | HB0753 | - 2 - | LRB097 03581 KTG 43618 b |
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| 1 | | (d) The Department shall not impose requirements for prior |
| 2 | | approval
based on a preferred drug list for anti-retroviral, |
| 3 | | anti-hemophilic factor
concentrates,
or
any atypical |
| 4 | | antipsychotics, conventional antipsychotics,
or |
| 5 | | anticonvulsants used for the treatment of serious mental
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| 6 | | illnesses
until 30 days after it has conducted a study of the |
| 7 | | impact of such
requirements on patient care and submitted a |
| 8 | | report to the Speaker of the
House of Representatives and the |
| 9 | | President of the Senate.
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| 10 | | (e) When making determinations as to which drugs shall be |
| 11 | | on a prior approval list, the Department shall include as part |
| 12 | | of the analysis for this determination, the degree to which a |
| 13 | | drug may affect individuals in different ways based on factors |
| 14 | | including the gender of the person taking the medication. |
| 15 | | (f)
(e) The Department shall cooperate with the Department |
| 16 | | of Public Health and the Department of Human Services Division |
| 17 | | of Mental Health in identifying psychotropic medications that, |
| 18 | | when given in a particular form, manner, duration, or frequency |
| 19 | | (including "as needed") in a dosage, or in conjunction with |
| 20 | | other psychotropic medications to a nursing home resident, may |
| 21 | | constitute a chemical restraint or an "unnecessary drug" as |
| 22 | | defined by the Nursing Home Care Act or Titles XVIII and XIX of |
| 23 | | the Social Security Act and the implementing rules and |
| 24 | | regulations. The Department shall require prior approval for |
| 25 | | any such medication prescribed for a nursing home resident that |
| 26 | | appears to be a chemical restraint or an unnecessary drug. The |