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Full Text of SB2046  97th General Assembly




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1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing 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
9under this Article for prescription drugs provided to a
10recipient of aid under this Article shall include the name of
11the prescriber or an acceptable identification number as
12established by the Department.
13    (b) Pharmacies providing prescription drugs under this
14Article shall be reimbursed at a rate which shall include a
15professional dispensing fee as determined by the Illinois
16Department, plus the current acquisition cost of the
17prescription drug dispensed. The Illinois Department shall
18update its information on the acquisition costs of all
19prescription drugs no less frequently than every 30 days.
20However, the Illinois Department may set the rate of
21reimbursement for the acquisition cost, by rule, at a
22percentage of the current average wholesale acquisition cost.
23    (c) (Blank).



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1    (d) The Department shall not impose requirements for prior
2approval based on a preferred drug list for anti-retroviral,
3anti-hemophilic factor concentrates, or any atypical
4antipsychotics, conventional antipsychotics, or
5anticonvulsants used for the treatment of serious mental
6illnesses until 30 days after it has conducted a study of the
7impact of such requirements on patient care and submitted a
8report to the Speaker of the House of Representatives and the
9President of the Senate. The Department shall review
10utilization of narcotic medications in the medical assistance
11program and impose utilization controls that protect against
13    (e) When making determinations as to which drugs shall be
14on a prior approval list, the Department shall include as part
15of the analysis for this determination, the degree to which a
16drug may affect individuals in different ways based on factors
17including the gender of the person taking the medication.
18    (f) The Department shall cooperate with the Department of
19Public Health and the Department of Human Services Division of
20Mental Health in identifying psychotropic medications that,
21when given in a particular form, manner, duration, or frequency
22(including "as needed") in a dosage, or in conjunction with
23other psychotropic medications to a nursing home resident, may
24constitute a chemical restraint or an "unnecessary drug" as
25defined by the Nursing Home Care Act or Titles XVIII and XIX of
26the Social Security Act and the implementing rules and



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1regulations. The Department shall require prior approval for
2any such medication prescribed for a nursing home resident that
3appears to be a chemical restraint or an unnecessary drug. The
4Department shall consult with the Department of Human Services
5Division of Mental Health in developing a protocol and criteria
6for deciding whether to grant such prior approval.
7    (g) The Department may by rule provide for reimbursement of
8the dispensing of a 90-day supply of a generic or brand name,
9non-narcotic maintenance medication in circumstances where it
10is cost effective.
11(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
1296-1501, eff. 1-25-11.)