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92_HB4000ham001 LRB9213598DJgcam02 1 AMENDMENT TO HOUSE BILL 4000 2 AMENDMENT NO. . Amend House Bill 4000 by replacing 3 everything after the enacting clause with the following: 4 "Section 5. The Illinois Public Aid Code is amended by 5 adding Sections 5-23 through 5-23.20 as follows: 6 (305 ILCS 5/5-23 new) 7 Sec. 5-23. Prescribed-drug spending-control program. 8 (a) Subject to appropriations, the Department of Public 9 Aid shall establish a Medicaid prescribed-drug 10 spending-control program that includes the components 11 described in Sections 5-23.5 through 5-23.20. 12 (b) The Department of Public Aid may contract all or any 13 part of the implementation of the Medicaid prescribed-drug 14 spending-control program to private organizations. 15 Notwithstanding any other provision of law, the Department, 16 at its discretion, may renew a contract or contracts for 17 fiscal intermediary services one or more times for periods 18 determined by the Department. All such renewals combined may 19 not exceed a total period longer than the term of the 20 original contract, however. 21 (305 ILCS 5/5-23.5 new) -2- LRB9213598DJgcam02 1 Sec. 5-23.5. Prior authorization. 2 (a) Except for anti-retroviral drugs and drugs used to 3 treat HIV or AIDS and opportunistic infections related to HIV 4 or AIDS, reimbursement for drugs not included in the list 5 established under Section 5-23.10 is subject to prior 6 authorization. As used in this Section, "HIV" and "AIDS" have 7 the meanings ascribed to those terms in the AIDS 8 Confidentiality Act. 9 (b) The Department of Public Aid may establish prior 10 authorization requirements for certain populations of 11 Medicaid beneficiaries, certain drug classes, or particular 12 drugs to prevent fraud, abuse, overuse, and possible 13 dangerous drug interactions. 14 (c) The drug and therapeutics advisory committee created 15 under Section 12-4.20 shall make recommendations to the 16 Department of Public Aid regarding drugs for which prior 17 authorization is required. The Department shall inform the 18 committee of the Department's decisions regarding drugs 19 subject to prior authorization. 20 (305 ILCS 5/5-23.10 new) 21 Sec. 5-23.10. Preferred drug list; supplemental rebates. 22 (a) The Department of Public Aid may establish a 23 preferred drug list in accordance with 42 U.S.C. 24 1396r-8(d)(1). In establishing the list, the Department may 25 negotiate supplemental rebates from manufacturers that are in 26 addition to those required by Title XIX of the Social 27 Security Act. There is no upper limit on the supplemental 28 rebates the Department may negotiate. The Department may 29 contract with an outside agency or contractor to conduct 30 negotiations for supplemental rebates. 31 (b) Agreement to pay the minimum supplemental rebate 32 percentage shall guarantee a manufacturer that the drug and 33 therapeutics advisory committee created under Section 12-4.20 -3- LRB9213598DJgcam02 1 will consider a product for inclusion in the preferred drug 2 list. A pharmaceutical manufacturer is not guaranteed 3 placement of a drug in the list simply by paying the minimum 4 supplemental rebate, however. Department of Public Aid 5 decisions must be based on the clinical efficacy of a drug 6 and recommendations of the drug and therapeutics advisory 7 committee, as well as the price of competing products minus 8 federal and State rebates. 9 (c) In this Section, "supplemental rebates" may include, 10 at the Department of Public Aid's discretion, cash rebates 11 and other program benefits that offset a Medicaid 12 expenditure. Those other program benefits may include, but 13 need not be limited to, disease management programs, drug 14 product donation programs, drug utilization control programs, 15 prescriber and beneficiary counseling and education, fraud 16 and abuse initiatives, and other services or administrative 17 investments with guaranteed savings to the Medicaid program 18 in the same year that the rebate reduction is included in the 19 appropriation to the Department for operation of the Medicaid 20 program. 21 (d) The Department of Public Aid shall seek any waivers 22 of federal law or regulations necessary to implement this 23 Section. 24 (e) A Medicaid recipient may appeal a decision of the 25 Department of Public Aid concerning the preferred drug list 26 in the same manner as the appeal of other decisions of the 27 Department under this Article. 28 (f) The Department of Public Aid shall publish and 29 disseminate the preferred drug list to all Medicaid vendors 30 in the State. 31 (305 ILCS 5/5-23.15 new) 32 Sec. 5-23.15. Drug and therapeutics advisory committee; 33 preferred drug list. -4- LRB9213598DJgcam02 1 (a) The drug and therapeutics advisory committee as 2 defined by rule shall develop its preferred drug list 3 recommendations by considering the clinical efficacy, safety, 4 and cost effectiveness of a product. To the extent feasible, 5 the committee shall review all drug classes included in the 6 preferred drug list at least every 12 months. The committee 7 may recommend additions to and deletions from the list so 8 that the list provides for medically appropriate drug 9 therapies for Medicaid patients which achieve cost savings 10 contained in appropriations to the Department of Public Aid 11 for operation of the Medicaid program. 12 (b) The committee shall ensure that pharmaceutical 13 manufacturers agreeing to provide a supplemental rebate as 14 provided in Section 5-23.10 have an opportunity to present 15 evidence supporting inclusion of a product in the preferred 16 drug list. Upon timely notice, the Department of Public Aid 17 shall ensure that any drug that has been approved or had any 18 of its particular uses approved by the United States Food and 19 Drug Administration under a priority review classification is 20 reviewed by the committee at the committee's next regularly 21 scheduled meeting. To the extent possible, upon notice by a 22 manufacturer, the Department shall also schedule a product 23 review for any new product at the committee's next regularly 24 scheduled meeting. 25 (305 ILCS 5/5-23.20 new) 26 Sec. 5-23.20. Report. The Department of Public Aid must 27 submit a report to the Governor, the President of the Senate, 28 and the Speaker of the House of Representatives by January 15 29 of each year. The report must include, but need not be 30 limited to, a discussion of the progress made in implementing 31 Medicaid cost-containment measures and their effect on 32 Medicaid prescribed-drug expenditures. -5- LRB9213598DJgcam02 1 Section 99. Effective date. This Act takes effect upon 2 becoming law.".
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