093_SB1386

 
                                     LRB093 10825 DRJ 11280 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.
18        In the fiscal year beginning July 1,  2003  and  every  2
19    years  thereafter,  the  Illinois  Department shall conduct a
20    survey of pharmacies providing prescription drugs under  this
21    Article to assess the appropriate level of dispensing fees to
22    be paid under this Section.
23        The  Illinois  Department shall update its information on
24    the acquisition costs  of  all  prescription  drugs  no  less
25    frequently   than   every  30  days.  However,  the  Illinois
26    Department  may  set  the  rate  of  reimbursement  for   the
27    acquisition  cost,  by  rule,  at a percentage of the current
28    average wholesale acquisition cost.
29        (c)  Reimbursement under this  Article  for  prescription
30    drugs  shall  be  limited  to  reimbursement for 4 brand-name
31    prescription drugs per patient per  month.   This  subsection
 
                            -2-      LRB093 10825 DRJ 11280 b
 1    applies  only  if  (i) the brand-name drug was not prescribed
 2    for an acute or urgent condition, (ii)  the  brand-name  drug
 3    was   not  prescribed  for  Alzheimer's  disease,  arthritis,
 4    diabetes, HIV/AIDS, a mental health condition, or respiratory
 5    disease,  and  (iii)  a  therapeutically  equivalent  generic
 6    medication has been approved by the  federal  Food  and  Drug
 7    Administration.
 8        (d)  The  Department  shall  not  impose requirements for
 9    prior  approval  based  on  a   preferred   drug   list   for
10    anti-retroviral  or any atypical antipsychotics, conventional
11    antipsychotics, or anticonvulsants used for the treatment  of
12    serious mental illnesses until 30 days after it has conducted
13    a  study  of  the impact of such requirements on patient care
14    and submitted a  report  to  the  Speaker  of  the  House  of
15    Representatives and the President of the Senate.
16    (Source:  P.A.  92-597,  eff.  6-28-02; 92-825, eff. 8-21-02;
17    revised 9-19-02.)