093_HB1431

 
                                     LRB093 08052 DRJ 08253 b

 1        AN ACT in relation to public aid.

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

 4        Section  5.   The  Illinois Public Aid Code is amended by
 5    changing 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
 9    reimbursement  under  this  Article  for  prescription  drugs
10    provided  to  a  recipient  of  aid  under this Article shall
11    include  the  name  of  the  prescriber  or   an   acceptable
12    identification   number   as   established  by  the  Illinois
13    Department.
14        (b)  Pharmacies providing prescription drugs  under  this
15    Article  shall  be  reimbursed  at a rate that includes which
16    shall include a professional dispensing fee as determined  by
17    the Illinois Department, plus the current acquisition cost of
18    the  prescription  drug  dispensed.  The  Illinois Department
19    shall update its information on the acquisition costs of  all
20    prescription  drugs  no  less  frequently than every 30 days.
21    However,  the  Illinois  Department  may  set  the  rate   of
22    reimbursement  for  the  acquisition  cost,  by  rule,  at  a
23    percentage of the current average wholesale acquisition cost.
24        (c)  Reimbursement  under  this  Article for prescription
25    drugs shall be limited  to  reimbursement  for  4  brand-name
26    prescription  drugs  per  patient per month.  This subsection
27    applies only if (i) the brand-name drug  was  not  prescribed
28    for  an  acute  or urgent condition, (ii) the brand-name drug
29    was  not  prescribed  for  Alzheimer's  disease,   arthritis,
30    diabetes, HIV/AIDS, a mental health condition, or respiratory
31    disease,  and  (iii)  a  therapeutically  equivalent  generic
 
                            -2-      LRB093 08052 DRJ 08253 b
 1    medication  has  been  approved  by the federal Food and Drug
 2    Administration.
 3        (d)  The Department shall  not  impose  requirements  for
 4    prior   approval   based   on   a  preferred  drug  list  for
 5    anti-retroviral or any atypical antipsychotics,  conventional
 6    antipsychotics,  or anticonvulsants used for the treatment of
 7    serious mental illnesses until 30 days after it has conducted
 8    a study of the impact of such requirements  on  patient  care
 9    and  submitted  a  report  to  the  Speaker  of  the House of
10    Representatives and the President of the Senate.
11    (Source: P.A. 92-597, eff.  6-28-02;  92-825,  eff.  8-21-02;
12    revised 9-19-02.)