HB4096 EnrolledLRB100 14436 KTG 29218 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 5-16.11 as follows:
 
6    (305 ILCS 5/5-16.11)
7    Sec. 5-16.11. Uniform standards applied to managed care
8organizations entities.
9    (a) As used in this Section:
10    "Drug class" means a set of medications that have similar
11chemical structures, the same mechanism of action (such as
12binding to the same biological target), a related mode of
13action, the same method of delivery (such as one pill per day),
14or that are used to treat the same disease.
15    "Clinician" means an individual licensed by the State of
16Illinois to prescribe or dispense drugs.
17    (b) Any Medicaid managed care organization entity
18providing services under this Code shall use a pharmacy
19formulary that is no more restrictive by drug class than the
20Illinois Department's preferred drug list. Beginning January
211, 2019 and continuing through January 1, 2022, the Illinois
22Department shall require each Medicaid managed care
23organization to list as preferred on the Medicaid managed care

 

 

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1organization's preferred drug list at least the same number,
2and no fewer, of drugs per drug class as are listed on the
3Illinois Department's preferred drug list. pharmaceutical
4program.
5    (c) The Illinois Department shall not prohibit, or adopt
6any rules or policies that prohibit, a Medicaid managed care
7organization from: (i) covering additional drugs that are not
8listed on the Illinois Department's preferred drug list; (ii)
9submitting all covered drugs listed on the Illinois
10Department's preferred drug list and additional drugs covered
11by the Medicaid managed care organization as qualified
12encounters to be used for appropriate purposes, including, but
13not limited to, quality scores, risk adjustments, and rate
14development, as long as the encounter data is submitted with
15proper formatting criteria; or (iii) removing from the Medicaid
16managed care organization's preferred drug list any prior
17approval requirements, step therapy, or other utilization
18controls applicable under the Illinois Department's preferred
19drug list.
20    (d) The Illinois Department shall not require a Medicaid
21managed care organization to utilize a single, statewide
22preferred drug list and shall not prohibit a plan from
23negotiating drug pricing concessions or rebates on any drug
24with pharmaceutical companies, unless otherwise required by
25federal law.
26    (e) No later than January 1, 2019, the Illinois Department

 

 

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1shall develop a standardized format for all Medicaid managed
2care organization preferred drug lists in collaboration with
3Medicaid managed care organizations and other stakeholders,
4including, but not limited to, organizations that serve
5individuals impacted by HIV/AIDS or epilepsy, and
6community-based organizations, providers, and entities with
7expertise in drug formulary development.
8    (f) Following development of the standardized Preferred
9Drug List format, the Illinois Department shall allow Medicaid
10managed care organizations 6 months from the date of completion
11to comply with the new Preferred Drug List format. Each
12Medicaid managed care organization must post its preferred drug
13list on its website without restricting access and must update
14the preferred drug list posted on its website. Medicaid managed
15care organizations shall publish updates to their preferred
16drug lists no less than 30 days prior to the date upon which
17any update or change takes effect, including, but not limited
18to, any and all changes to requirements for prior approval
19requirements, step therapy, or other utilization controls.
20    (g)(1) No later than January 1, 2019, the Illinois
21Department shall establish and maintain the Illinois Pharmacy
22and Therapeutics Advisory Board. The Board shall have the
23authority and responsibility to provide recommendations to the
24Illinois Department regarding which drug products to list on
25the Illinois Department's preferred drug list. The Illinois
26Department shall provide administrative support to the Board

 

 

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1and the Board shall:
2        (A) convene and meet no less than once per calendar
3    quarter;
4        (B) provide regular opportunities for public comment;
5    and
6        (C) comply with the provisions of the Open Meetings
7    Act.
8    All correspondence related to the Board, including
9correspondence to and from Board members, shall be subject to
10the Freedom of Information Act.
11    (2) The Board shall consist of the following voting
12members, all of whom shall be appointed by the Governor and
13shall serve terms of 3 years without compensation:
14        (A) one pharmacist licensed to practice pharmacy in
15    Illinois who is recommended by a statewide organization
16    representing pharmacists;
17        (B) 4 physicians, recommended by a statewide
18    organization representing physicians, who are licensed to
19    practice medicine in all its branches in Illinois, have
20    knowledge of and adhere to best practice standards, and
21    have experience treating Illinois Medicaid beneficiaries;
22        (C) 2 clinicians representing health care advocacy
23    organizations that serve individuals who are affected by
24    chronic diseases that require significant pharmaceutical
25    treatments;
26        (D) one clinician representing the Illinois

 

 

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1    Department; and
2        (E) one licensed psychiatrist, recommended by a
3    statewide organization representing psychiatrists, who has
4    experience treating Illinois Medicaid beneficiaries.
5    One non-voting clinician representing each Medicaid health
6plan operating within the State shall be invited to participate
7and advise the Board on its recommendations to the Illinois
8Department.
9    Organizations interested in nominating non-voting
10clinicians to advise the Board may submit requests to
11participate to the Illinois Department.
12    (h) The Illinois Department shall adopt rules, to be in
13place no later than January 1, 2019, for the purpose of
14establishing and maintaining the Board.
15(Source: P.A. 92-370, eff. 8-15-01.)
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.