Illinois General Assembly - Full Text of Public Act 097-0426

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Public Act 097-0426

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Public Act 0426 97TH GENERAL ASSEMBLY

Public Act 097-0426

SB2046 Enrolled LRB097 10049 KTG 50225 b

    AN ACT concerning public aid.

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

    Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.12 as follows:

    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
    Sec. 5-5.12. Pharmacy payments.
    (a) Every request submitted by a pharmacy for reimbursement
under this Article for prescription drugs provided to a
recipient of aid under this Article shall include the name of
the prescriber or an acceptable identification number as
established by the Department.
    (b) Pharmacies providing prescription drugs under this
Article shall be reimbursed at a rate which shall include a
professional dispensing fee as determined by the Illinois
Department, plus the current acquisition cost of the
prescription drug dispensed. The Illinois Department shall
update its information on the acquisition costs of all
prescription drugs no less frequently than every 30 days.
However, the Illinois Department may set the rate of
reimbursement for the acquisition cost, by rule, at a
percentage of the current average wholesale acquisition cost.
    (c) (Blank).
    (d) The Department shall not impose requirements for prior
approval based on a preferred drug list for anti-retroviral,
anti-hemophilic factor concentrates, or any atypical
antipsychotics, conventional antipsychotics, or
anticonvulsants used for the treatment of serious mental
illnesses until 30 days after it has conducted a study of the
impact of such requirements on patient care and submitted a
report to the Speaker of the House of Representatives and the
President of the Senate. The Department shall review
utilization of narcotic medications in the medical assistance
program and impose utilization controls that protect against
abuse.
    (e) When making determinations as to which drugs shall be
on a prior approval list, the Department shall include as part
of the analysis for this determination, the degree to which a
drug may affect individuals in different ways based on factors
including the gender of the person taking the medication.
    (f) The Department shall cooperate with the Department of
Public Health and the Department of Human Services Division of
Mental Health in identifying psychotropic medications that,
when given in a particular form, manner, duration, or frequency
(including "as needed") in a dosage, or in conjunction with
other psychotropic medications to a nursing home resident, may
constitute a chemical restraint or an "unnecessary drug" as
defined by the Nursing Home Care Act or Titles XVIII and XIX of
the Social Security Act and the implementing rules and
regulations. The Department shall require prior approval for
any such medication prescribed for a nursing home resident that
appears to be a chemical restraint or an unnecessary drug. The
Department shall consult with the Department of Human Services
Division of Mental Health in developing a protocol and criteria
for deciding whether to grant such prior approval.
    (g) The Department may by rule provide for reimbursement of
the dispensing of a 90-day supply of a generic or brand name,
non-narcotic maintenance medication in circumstances where it
is cost effective.
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
96-1501, eff. 1-25-11.)

Effective Date: 1/1/2012

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