Rep. Gregory Harris

Filed: 4/23/2018

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 4096

2    AMENDMENT NO. ______. Amend House Bill 4096 by replacing
3everything after the enacting clause with the following:
 
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.

 

 

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1    (b) Any Medicaid managed care organization entity
2providing services under this Code shall use a pharmacy
3formulary that is no more restrictive by drug class than the
4Illinois Department's preferred drug list. Beginning January
51, 2019 and continuing through January 1, 2022, the Illinois
6Department shall require each Medicaid managed care
7organization to list as preferred on the Medicaid managed care
8organization's preferred drug list at least the same number,
9and no fewer, of drugs per drug class as are listed on the
10Illinois Department's preferred drug list. pharmaceutical
11program.
12    (c) The Illinois Department shall not prohibit, or adopt
13any rules or policies that prohibit, a Medicaid managed care
14organization from: (i) covering additional drugs that are not
15listed on the Illinois Department's preferred drug list; (ii)
16submitting all covered drugs listed on the Illinois
17Department's preferred drug list and additional drugs covered
18by the Medicaid managed care organization as qualified
19encounters to be used for appropriate purposes, including, but
20not limited to, quality scores, risk adjustments, and rate
21development, as long as the encounter data is submitted with
22proper formatting criteria; or (iii) removing from the Medicaid
23managed care organization's preferred drug list any prior
24approval requirements, step therapy, or other utilization
25controls applicable under the Illinois Department's preferred
26drug list.

 

 

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1    (d) The Illinois Department shall not require a Medicaid
2managed care organization to utilize a single, statewide
3preferred drug list and shall not prohibit a plan from
4negotiating drug pricing concessions or rebates on any drug
5with pharmaceutical companies, unless otherwise required by
6federal law.
7    (e) No later than January 1, 2019, the Illinois Department
8shall develop a standardized format for all Medicaid managed
9care organization preferred drug lists in collaboration with
10Medicaid managed care organizations and other stakeholders,
11including, but not limited to, organizations that serve
12individuals impacted by HIV/AIDS or epilepsy, and
13community-based organizations, providers, and entities with
14expertise in drug formulary development.
15    (f) Following development of the standardized Preferred
16Drug List format, the Illinois Department shall allow Medicaid
17managed care organizations 6 months from the date of completion
18to comply with the new Preferred Drug List format. Each
19Medicaid managed care organization must post its preferred drug
20list on its website without restricting access and must update
21the preferred drug list posted on its website. Medicaid managed
22care organizations shall publish updates to their preferred
23drug lists no less than 30 days prior to the date upon which
24any update or change takes effect, including, but not limited
25to, any and all changes to requirements for prior approval
26requirements, step therapy, or other utilization controls.

 

 

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1    (g)(1) No later than January 1, 2019, the Illinois
2Department shall establish and maintain the Illinois Pharmacy
3and Therapeutics Advisory Board. The Board shall have the
4authority and responsibility to provide recommendations to the
5Illinois Department regarding which drug products to list on
6the Illinois Department's preferred drug list. The Illinois
7Department shall provide administrative support to the Board
8and the Board shall:
9        (A) convene and meet no less than once per calendar
10    quarter;
11        (B) provide regular opportunities for public comment;
12    and
13        (C) comply with the provisions of the Open Meetings
14    Act.
15    All correspondence related to the Board, including
16correspondence to and from Board members, shall be subject to
17the Freedom of Information Act.
18    (2) The Board shall consist of the following voting
19members, all of whom shall be appointed by the Governor and
20shall serve terms of 3 years without compensation:
21        (A) one pharmacist licensed to practice pharmacy in
22    Illinois who is recommended by a statewide organization
23    representing pharmacists;
24        (B) 4 physicians, recommended by a statewide
25    organization representing physicians, who are licensed to
26    practice medicine in all its branches in Illinois, have

 

 

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1    knowledge of and adhere to best practice standards, and
2    have experience treating Illinois Medicaid beneficiaries;
3        (C) 2 clinicians representing health care advocacy
4    organizations that serve individuals who are affected by
5    chronic diseases that require significant pharmaceutical
6    treatments;
7        (D) one clinician representing the Illinois
8    Department; and
9        (E) one licensed psychiatrist, recommended by a
10    statewide organization representing psychiatrists, who has
11    experience treating Illinois Medicaid beneficiaries.
12    One non-voting clinician representing each Medicaid health
13plan operating within the State shall be invited to participate
14and advise the Board on its recommendations to the Illinois
15Department.
16    Organizations interested in nominating non-voting
17clinicians to advise the Board may submit requests to
18participate to the Illinois Department.
19    (h) The Illinois Department shall adopt rules, to be in
20place no later than January 1, 2019, for the purpose of
21establishing and maintaining the Board.
22(Source: P.A. 92-370, eff. 8-15-01.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.".