Illinois General Assembly - Full Text of SR0792
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Full Text of SR0792  102nd General Assembly




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2    WHEREAS, The Medicaid program in Illinois has an immense
3and growing impact, both in terms of taxpayer dollars and in
4the effect it has on citizens across the State; and
5    WHEREAS, State resources for healthcare services are
6scarce, and many healthcare providers, including pharmacists,
7are discontinuing services or ceasing operation, leading to a
8profoundly detrimental impact on our communities and the
9expansion of pharmacy deserts; and
10    WHEREAS, Enrollment under the Illinois Department of
11Healthcare and Family Services' Medical Assistance Programs
12(Medicaid) exceeds three million; and
13    WHEREAS, A sizable portion of the Medicaid population is
14currently enrolled, often mandatorily, in Managed Care
15Organizations (MCOs), making outlays to MCOS, measured in
16billions of dollars, one of the largest disbursements in the
17State; and
18    WHEREAS, 12,500 licensed pharmacists in Illinois provide
19medications and patient care services to assure the rational
20and safe use of all medications; and



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1    WHEREAS, Pharmacists, as front-line healthcare providers,
2answered the call to aid during the ongoing COVID-19 pandemic
3and have assumed additional responsibilities of care and
4practice in order to best serve the public health needs of the
5citizens of the State of Illinois; and
6    WHEREAS, A significant number of pharmacists respond to
7the charge of their community to establish a pharmacy to
8provide access to care for their patients; and
9    WHEREAS, Pharmacies generate additional taxable revenue
10for the State and yet are continuously reimbursed below their
11cost on medications dispensed to meet their patient's needs;
13    WHEREAS, Pharmacy benefit managers are companies that
14manage prescription drug benefits on behalf of Illinois'
15Managed Care Programs, which includes providing claims
16processing services or other prescription drug services; and
17    WHEREAS, Public Act 101-452, which was signed into law
18August 23, 2019 and went into effect on January 1, 2020,
19provides oversight of pharmacy benefit managers; and
20    WHEREAS, A number of other states have performed audits
21evaluating the role and benefit of pharmacy benefit managers;



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2    WHEREAS, It is paramount that the General Assembly stay
3engaged in Medicaid funding and corresponding healthcare
4outcome issues and be prepared to make legislative and
5administrative recommendations; therefore, be it
7ASSEMBLY OF THE STATE OF ILLINOIS, that the Auditor General is
8directed to conduct a performance audit of the Department of
9Healthcare and Family Services' administration of pharmacy
10benefit managers; and be it further
11    RESOLVED, That the performance audit include, but not be
12limited to, the following determinations:
13        (1) The amount of State and federal funds used by
14    managed care organizations to reimburse pharmacy benefit
15    managers and, in time, the amount paid by pharmacy benefit
16    managers to reimburse pharmacies for fiscal years 2020 and
17    2021;
18        (2) An examination of contracts between managed care
19    organizations and pharmacy benefit managers and between
20    pharmacy benefit managers and pharmacies receiving
21    reimbursement;
22        (3) The level of oversight the Department of
23    Healthcare and Family Services provides over the contracts



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1    and over the pharmacy benefit managers to ensure
2    compliance with contract requirements;
3        (4) An overview of the distribution of and payments
4    for pharmaceuticals in the medical assistance managed care
5    program;
6        (5) A review of the reimbursement practices and
7    reimbursement rates of managed care organizations to
8    pharmacy benefit managers; and
9        (6) A review of the reimbursement practices and
10    reimbursement rates of pharmacy benefit managers to
11    pharmacies, including out-of-state pharmacies and
12    pharmacies affiliated with pharmacy benefit managers; and
13    be it further
14    RESOLVED, That the Illinois Department of Healthcare and
15Family Services, as well as any other entity that may have
16information pertaining to this audit, cooperate fully and
17promptly with the Auditor General's Office in the conduct of
18this audit; and be it further
19    RESOLVED, That the Auditor General commence this audit as
20soon as possible and report his findings and recommendations
21upon completion in accordance with the provisions of Section
223-14 of the Illinois State Auditing Act; and be it further
23    RESOLVED, That a copy of this resolution be delivered to



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1the Auditor General and the Illinois Department of Healthcare
2and Family Services.