94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB5272

 

Introduced 01/25/06, by Rep. Kathleen A. Ryg - Patricia R. Bellock

 

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

    Amends the Illinois Public Aid Code. Provides that reimbursement under the Medicaid program for prescription drugs shall be limited to reimbursement for 4 brand-name prescription drugs per patient per month. Provides that this limitation does not apply if (i) the brand-name drug was prescribed for an acute or urgent condition, (ii) the brand-name drug was prescribed for Alzheimer's disease, arthritis, diabetes, HIV/AIDS, a mental health condition, hemophilia, or respiratory diseases, (iii) the brand-name drug was prescribed for less than 30 days for acute infections, and (iv) a therapeutically equivalent generic medication has not been approved by the federal Food and Drug Administration. Effective July 1, 2006.


LRB094 18104 DRJ 53409 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5272 LRB094 18104 DRJ 53409 b

1     AN ACT concerning 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 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 does
26 not apply if (i) the brand-name drug was prescribed for an
27 acute or urgent condition, (ii) the brand-name drug was
28 prescribed for Alzheimer's disease, arthritis, diabetes,
29 HIV/AIDS, a mental health condition, hemophilia, or
30 respiratory diseases, (iii) the brand-name drug was prescribed
31 for less than 30 days for acute infections, and (iv) a
32 therapeutically equivalent generic medication has not been

 

 

HB5272 - 2 - LRB094 18104 DRJ 53409 b

1 approved by the federal Food and Drug Administration. (Blank).
2     (d) The Department shall not impose requirements for prior
3 approval based on a preferred drug list for anti-retroviral,
4 anti-hemophilic factor concentrates, or any atypical
5 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. 93-106, eff. 7-8-03; 94-48, eff. 7-1-05.)
 
12     Section 99. Effective date. This Act takes effect July 1,
13 2006.