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92_HB4000ham001
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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)
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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
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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.
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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.
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1 Section 99. Effective date. This Act takes effect upon
2 becoming law.".