93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4970

 

Introduced 02/05/04, by Rosemary Mulligan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.12   from Ch. 23, par. 5-5.12

    Amends the Illinois Public Aid Code. Makes technical changes in a Section concerning pharmacy payments under the Medicaid program.


LRB093 18795 DRJ 44529 b

 

 

A BILL FOR

 

HB4970 LRB093 18795 DRJ 44529 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 reimbursement
9 under this Article for prescription drugs provided to a
10 recipient of aid under this Article shall include the name of
11 the prescriber or an acceptable identification number as
12 established by the Illinois Department.
13     (b) Pharmacies providing prescription drugs under this
14 Article shall be reimbursed at a rate that includes which shall
15 include a professional dispensing fee as determined by the
16 Illinois 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 for
27 an acute or urgent condition, (ii) the brand-name drug was not
28 prescribed for Alzheimer's disease, arthritis, diabetes,
29 HIV/AIDS, a mental health condition, or respiratory disease,
30 and (iii) a therapeutically equivalent generic medication has
31 been approved by the federal Food and Drug Administration.
32     (d) The Department shall not impose requirements for prior

 

 

HB4970 - 2 - LRB093 18795 DRJ 44529 b

1 approval based on a preferred drug list for anti-retroviral,
2 anti-hemophilic factor concentrates, or any atypical
3 antipsychotics, conventional antipsychotics, or
4 anticonvulsants used for the treatment of serious mental
5 illnesses until 30 days after it has conducted a study of the
6 impact of such requirements on patient care and submitted a
7 report to the Speaker of the House of Representatives and the
8 President of the Senate.
9 (Source: P.A. 92-597, eff. 6-28-02; 92-825, eff. 8-21-02;
10 93-106, eff. 7-8-03.)