97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB3213

 

Introduced 2/1/2012, by Sen. David Koehler

 

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

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall by rule establish the drugs, excluding clotting factor, required to be dispensed in the Department's pharmacy specialty drugs program (rather than the Department shall by rule establish the drugs required to be dispensed in the Department's pharmacy specialty drugs program).


LRB097 19090 KTG 64329 b

 

 

A BILL FOR

 

SB3213LRB097 19090 KTG 64329 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 name of
11the 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. The Department shall review
10utilization of narcotic medications in the medical assistance
11program and impose utilization controls that protect against
12abuse.
13    (e) When making determinations as to which drugs shall be
14on a prior approval list, the Department shall include as part
15of the analysis for this determination, the degree to which a
16drug may affect individuals in different ways based on factors
17including the gender of the person taking the medication.
18    (f) The Department shall cooperate with the Department of
19Public Health and the Department of Human Services Division of
20Mental Health in identifying psychotropic medications that,
21when given in a particular form, manner, duration, or frequency
22(including "as needed") in a dosage, or in conjunction with
23other psychotropic medications to a nursing home resident or to
24a resident of a facility licensed under the ID/DD MR/DD
25Community Care Act, may constitute a chemical restraint or an
26"unnecessary drug" as defined by the Nursing Home Care Act or

 

 

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1Titles XVIII and XIX of the Social Security Act and the
2implementing rules and regulations. The Department shall
3require prior approval for any such medication prescribed for a
4nursing home resident or to a resident of a facility licensed
5under the ID/DD MR/DD Community Care Act, that appears to be a
6chemical restraint or an unnecessary drug. The Department shall
7consult with the Department of Human Services Division of
8Mental Health in developing a protocol and criteria for
9deciding whether to grant such prior approval.
10    (g) The Department may by rule provide for reimbursement of
11the dispensing of a 90-day supply of a generic or brand name,
12non-narcotic maintenance medication in circumstances where it
13is cost effective.
14    (h) Effective July 1, 2011, the Department shall
15discontinue coverage of select over-the-counter drugs,
16including analgesics and cough and cold and allergy
17medications.
18    (i) The Department shall seek any necessary waiver from the
19federal government in order to establish a program limiting the
20pharmacies eligible to dispense specialty drugs and shall issue
21a Request for Proposals in order to maximize savings on these
22drugs. The Department shall by rule establish the drugs,
23excluding clotting factor, required to be dispensed in this
24program.
25(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
2696-1501, eff. 1-25-11; 97-38, eff. 6-28-11; 97-74, eff.

 

 

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16-30-11; 97-333, eff. 8-12-11; 97-426, eff. 1-1-12; revised
210-4-11.)