093_HB1268eng

HB1268 Engrossed                     LRB093 05340 DRJ 06191 b

 1        AN ACT in relation to public aid.

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

 4        Section 5. The Illinois Public Aid  Code  is  amended  by
 5    changing Section 5-5.12 as follows:

 6        (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
 7        Sec. 5-5.12.  Pharmacy payments.
 8        (a)  Every   request   submitted   by   a   pharmacy  for
 9    reimbursement  under  this  Article  for  prescription  drugs
10    provided to a recipient  of  aid  under  this  Article  shall
11    include   the   name  of  the  prescriber  or  an  acceptable
12    identification number as established by the Department.
13        (b)  Pharmacies providing prescription drugs  under  this
14    Article  shall  be reimbursed at a rate which shall include a
15    professional dispensing fee as  determined  by  the  Illinois
16    Department,   plus   the  current  acquisition  cost  of  the
17    prescription drug dispensed. The  Illinois  Department  shall
18    update  its  information  on  the  acquisition  costs  of all
19    prescription drugs no less frequently  than  every  30  days.
20    However,   the  Illinois  Department  may  set  the  rate  of
21    reimbursement  for  the  acquisition  cost,  by  rule,  at  a
22    percentage of the current average wholesale acquisition cost.
23        (c)  Reimbursement under this  Article  for  prescription
24    drugs  shall  be  limited  to  reimbursement for 4 brand-name
25    prescription drugs per patient per  month.   This  subsection
26    applies  only  if  (i) the brand-name drug was not prescribed
27    for an acute or urgent condition, (ii)  the  brand-name  drug
28    was   not  prescribed  for  Alzheimer's  disease,  arthritis,
29    diabetes, HIV/AIDS, a mental health condition, or respiratory
30    disease,  and  (iii)  a  therapeutically  equivalent  generic
31    medication has been approved by the  federal  Food  and  Drug
 
HB1268 Engrossed            -2-      LRB093 05340 DRJ 06191 b
 1    Administration.
 2        (d)  The  Department  shall  not  impose requirements for
 3    prior  approval  based  on  a   preferred   drug   list   for
 4    anti-retroviral,  anti-hemophilic factor concentrates, or any
 5    atypical  antipsychotics,  conventional  antipsychotics,   or
 6    anticonvulsants  used  for  the  treatment  of serious mental
 7    illnesses until 30 days after it has conducted a study of the
 8    impact of such requirements on patient care and  submitted  a
 9    report to the Speaker of the House of Representatives and the
10    President of the Senate.
11    (Source:  P.A.  92-597,  eff.  6-28-02; 92-825, eff. 8-21-02;
12    revised 9-19-02.)

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