093_HB0107

 
                                     LRB093 03403 JLS 03421 b

 1        AN ACT relating to managed care.

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

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

 6        (215 ILCS 134/72)
 7        Sec. 72.  Pharmacy providers.
 8        (a)  Before  entering  into an  agreement  with  pharmacy
 9    providers,  a  health  care  plan  must  establish  terms and
10    conditions that must be met by pharmacy providers desiring to
11    contract with the health care plan. The terms and  conditions
12    shall  not discriminate against a pharmacy provider. A health
13    care plan may not refuse to contract with a pharmacy provider
14    that meets the terms and conditions established by the health
15    care plan.  If a pharmacy  provider  rejects  the  terms  and
16    conditions  established, the health care plan may offer other
17    terms  and  conditions  necessary  to  comply  with   network
18    adequacy  requirements.   This  subsection shall not apply if
19    the health care plan is wholly owned by a  physicians'  group
20    organized under the Professional Service Corporation Act.
21        (b)  A   health   care   plan   shall   apply   the  same
22    co-insurance, copayment, and deductible factors to  all  drug
23    prescriptions filled by a pharmacy provider that participates
24    in   the   health   care  plan's  network.  Nothing  in  this
25    subsection,  however,  prohibits  a  health  care  plan  from
26    applying different co-insurance,  copayment,  and  deductible
27    factors  between  brand  name  drugs and generic drugs when a
28    generic equivalent exists for the brand name drug.
29        (c)  A health care plan  may  not  set  a  limit  on  the
30    quantity  of  drugs  that  an enrollee may obtain at one time
31    with a prescription unless the limit is applied uniformly  to
 
                            -2-      LRB093 03403 JLS 03421 b
 1    all pharmacy providers in the health care plan's network.
 2    (Source: P.A. 91-617, eff. 1-1-00.)