TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.445 LEGEND PRESCRIPTION ITEMS (NOT COMPOUNDED)


 

Section 140.445  Legend Prescription Items (Not Compounded)

 

a)         Effective July 1, 2012, for legend (prescription) drugs, the Department shall pay the lower of:

 

1)         the pharmacy's usual and customary charge to the general public;

 

2)         the Department's maximum price plus the established dispensing fee of $5.50 for generic drugs and $2.40 for brand name drugs.  The Department shall pay only one dispensing fee per 30 days' supply for those drugs dispensed in accordance with Section 140.443(h);

 

3)         For generic drugs, the Department's maximum price is calculated as the lowest of:

 

A)        Wholesale Acquisition Cost (WAC); or

 

B)        the Federal upper limit as established under section 1927(e)(4) of the Social Security Act (42 USC 1396r-8(e)(4)); or

 

C)        the State upper limit; or

 

4)         For brand name drugs, the Department's maximum price is calculated as the lower of:

 

A)        WAC; or

 

B)        the State upper limit.

 

b)         Effective February 1, 2013, for generic and brand name drugs purchased under the federal drug pricing program established under Section 340B of the federal Public Health Services Act, the Department shall pay the actual acquisition cost for the drug, as billed by the provider, or the Department's established 340B allowable reimbursement rate for the drug, plus a dispensing fee of $12.00 for brand and generic drugs.

 

(Source:  Amended at 37 Ill. Reg. 10282, effective June 27, 2013)