093_HB0107ham003

 










                                     LRB093 03403 JLS 14444 a

 1                     AMENDMENT TO HOUSE BILL 107

 2        AMENDMENT NO.     .  Amend House Bill 107, AS AMENDED, by
 3    replacing the title with the following:

 4        "AN ACT relating to managed care."; and

 5    by replacing everything after the enacting  clause  with  the
 6    following:

 7        "Section  5.  The  Managed Care Reform and Patient Rights
 8    Act is amended by changing Section 72 as follows:

 9        (215 ILCS 134/72)
10        Sec. 72.  Pharmacy providers.
11        (a)  Before  entering  into an  agreement  with  pharmacy
12    providers, a  health  care  plan  must  establish  terms  and
13    conditions that must be met by pharmacy providers desiring to
14    contract  with the health care plan. The terms and conditions
15    shall not discriminate against a pharmacy provider. A  health
16    care plan may not refuse to contract with a pharmacy provider
17    that meets the terms and conditions established by the health
18    care  plan.    If  a  pharmacy provider rejects the terms and
19    conditions established, the health care plan may offer  other
20    terms   and  conditions  necessary  to  comply  with  network
21    adequacy requirements.  The provisions of this subsection are
 
                            -2-      LRB093 03403 JLS 14444 a
 1    subject to the limitations provided in subsection (a-5).
 2        (a-5)  Subsection (a) of this  Section  shall  not  apply
 3    with  respect  to  pharmacy providers located in Champaign or
 4    Piatt county if the health care plan is  wholly  owned  by  a
 5    physician's  group  organized  under the Professional Service
 6    Corporation Act and the  principal  business  office  of  the
 7    physician's  group  is  located  in  a  municipality  with  a
 8    population  of  less  than 50,000 inhabitants and is within 5
 9    miles of the principal business office  of  the  health  care
10    plan.
11        This  subsection  (a-5) is inoperative after December 31,
12    2007.
13        (b)  A  health   care   plan   shall   apply   the   same
14    co-insurance,  copayment,  and deductible factors to all drug
15    prescriptions filled by a pharmacy provider that participates
16    in  the  health  care  plan's  network.   Nothing   in   this
17    subsection,  however,  prohibits  a  health  care  plan  from
18    applying  different  co-insurance,  copayment, and deductible
19    factors between brand name drugs and  generic  drugs  when  a
20    generic equivalent exists for the brand name drug.
21        (c)  A  health  care  plan  may  not  set  a limit on the
22    quantity of drugs that an enrollee may  obtain  at  one  time
23    with  a prescription unless the limit is applied uniformly to
24    all pharmacy providers in the health care plan's network.
25    (Source: P.A. 91-617, eff. 1-1-00.)

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