HB4096 100TH GENERAL ASSEMBLY

LRB100 14436 KTG 29218 b

100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4096

Introduced , by Rep. Gregory Harris

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-16.11

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall require each Medicaid Managed Care Organization to list as preferred on the Medicaid Managed Care Organization's preferred drug list every pharmaceutical that is listed as preferred on the Department's preferred drug list. Provides that the Department shall not prohibit, or adopt any rules or policies that prohibit, a Medicaid Managed Care Organization from: (i) covering additional pharmaceuticals that are not listed on the Department's preferred drug list; or (ii) removing from the Medicaid Managed Care Organization's preferred drug list any prior approval requirements applicable under the Department's preferred drug list. Provides that the Department shall not require a Medicaid Managed Care Organization to utilize a single, statewide preferred drug list and shall not prohibit a plan from negotiating drug pricing concessions or rebates on any drug with pharmaceutical companies, unless otherwise required by federal law. Provides that no later than July 1, 2018, the Department shall develop a standardized format for all Medicaid Managed Care Organization preferred drug lists in cooperation with Medicaid Managed Care Organizations and stakeholders, including, but not limited to, community-based organizations, providers, and individuals or entities with expertise in drug formulary development. Requires each Medicaid Managed Care Organization to post its preferred drug list on its website without restricting access to enrolled members and to update the preferred drug list posted on its website within 2 business days of making any changes to the preferred drug list, including, but not limited to, any and all changes to requirements for prior approval. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

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

Section 5. The Illinois Public Aid Code is amended by changing Section 5-16.11 as follows:

(305 ILCS 5/5-16.11)

Sec. 5-16.11. Uniform standards applied to managed care entities.

(a) As used in this Section:

"Preferred drug list" means a list of preferred and non-preferred pharmaceuticals.

"Preferred pharmaceutical" means a pharmaceutical covered under the medical assistance program that is not subject to prior authorization or other utilization controls.

"Non-preferred pharmaceutical" means a pharmaceutical covered under the medical assistance program that is subject to prior authorization or other utilization controls.

(b) Any managed care entity providing services under this Code shall use a pharmacy formulary that is no more restrictive than the Illinois Department's pharmaceutical program.

(c) The Illinois Department shall require each Medicaid Managed Care Organization to list as preferred on the Medicaid Managed Care Organization's preferred drug list every pharmaceutical that is listed as preferred on the Illinois Department's preferred drug list. The Illinois Department shall not prohibit, or adopt any rules or policies that prohibit, a Medicaid Managed Care Organization from: (i) covering additional pharmaceuticals that are not listed on the Illinois Department's preferred drug list; or (ii) removing from the Medicaid Managed Care Organization's preferred drug list any prior approval requirements applicable under the Illinois Department's preferred drug list.

The Illinois Department shall not require a Medicaid Managed Care Organization to utilize a single, statewide preferred drug list and shall not prohibit a plan from negotiating drug pricing concessions or rebates on any drug with pharmaceutical companies, unless otherwise required by federal law.

No later than July 1, 2018, the Illinois Department shall develop a standardized format for all Medicaid Managed Care Organization preferred drug lists in cooperation with Medicaid Managed Care Organizations and stakeholders, including, but not limited to, community-based organizations, providers, and individuals or entities with expertise in drug formulary development. Each Medicaid Managed Care Organization must post its preferred drug list on its website without restricting access to enrolled members and must update the preferred drug list posted on its website within 2 business days of making any changes to the preferred drug list, including, but not limited to, any and all changes to requirements for prior approval.

(Source: P.A. 92-370, eff. 8-15-01.)

Section 99. Effective date. This Act takes effect upon becoming law.