101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3811

 

Introduced , by Rep. Mark Batinick

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Provides that the Director of Public Health, if a physician licensed to practice medicine in all its branches in Illinois, shall establish a standing order complete with the issuance of a prescription for a hormonal contraceptive in accordance with the requirements of the provisions. Provides that if the Director is not a physician licensed to practice medicine in all its branches in Illinois, the Medical Director of the Department of Public Health shall establish the standing order. Provides that a pharmacist may dispense a 12-month supply of hormonal contraceptives to a patient who is age 17 or older. Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or managed care plan to provide coverage for patient care services provided by a pharmacist. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code. Amends the Pharmacy Practice Act. Provides that the definition of "practice of pharmacy" includes the dispensing of hormonal contraceptives pursuant to the standing order under provisions of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Amends the Illinois Public Aid Code. Requires the medical assistance program to cover patient care services provided by a pharmacist for hormonal contraceptives assessment and consultation for patients who are age 17 or older. Effective January 1, 2020.


LRB101 11591 RAB 57590 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB3811LRB101 11591 RAB 57590 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 100-1170)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and
17356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
18The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
20Illinois Insurance Code. The Department of Insurance shall
21enforce the requirements of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
71-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
81-8-19.)
 
9    (Text of Section after amendment by P.A. 100-1170)
10    Sec. 6.11. Required health benefits; Illinois Insurance
11Code requirements. The program of health benefits shall provide
12the post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t of
14the Illinois Insurance Code. The program of health benefits
15shall provide the coverage required under Sections 356g,
16356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
19and 356z.32, and 356z.33 of the Illinois Insurance Code. The
20program of health benefits must comply with Sections 155.22a,
21155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
22Insurance Code. The Department of Insurance shall enforce the
23requirements of this Section with respect to Sections 370c and
24370c.1 of the Illinois Insurance Code; all other requirements
25of this Section shall be enforced by the Department of Central

 

 

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1Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
9100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
101-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
11100-1170, eff. 6-1-19.)
 
12    Section 10. The Department of Public Health Powers and
13Duties Law of the Civil Administrative Code of Illinois is
14amended by adding Section 2310-705 as follows:
 
15    (20 ILCS 2310/2310-705 new)
16    Sec. 2310-705. Contraceptive drugs and products; Director
17standing order.
18    (a) As used in this Section:
19    "Hormonal contraceptive" means a prescribed
20medically-acceptable oral drug, transdermal patch, or vaginal
21ring that is approved by the United States Food and Drug
22Administration to prevent pregnancy.
23    "Standing order" has the meaning given to that term in the
24Pharmacy Practice Act.

 

 

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1    (b) If the Director of Public Health is a physician
2licensed to practice medicine in all its branches in Illinois,
3the Director shall establish a standing order complete with the
4issuance of a prescription for a hormonal contraceptive in
5accordance with this Section. If the Director is not a
6physician licensed to practice medicine in all its branches in
7Illinois, then the Medical Director of the Department of Public
8Health shall establish a standing order in accordance with this
9Section.
10    (c) The standing order, at a minimum, shall comply with the
11following:
12        (1) A pharmacist may dispense a 12-month supply of
13    hormonal contraceptives to a patient who is age 17 or
14    older.
15        (2) A pharmacist shall have the patient complete the
16    self-screening risk assessment tool. The self-screening
17    risk assessment tool is to be based on the most current
18    version of the United States Medical Eligibility Criteria
19    for Contraceptive Use published by the federal Centers for
20    Disease Control and Prevention.
21        (3) Based upon the results of the self-screening risk
22    assessment and the patient assessment, the pharmacist
23    shall use his or her professional and clinical judgment as
24    to when a patient should be referred to the patient's
25    physician or another health care provider.
26        (4) The pharmacist shall provide, during the patient

 

 

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1    assessment and consultation, counseling and education
2    about all methods of contraception, including methods not
3    covered under the standing order, and their proper use and
4    effectiveness.
5        (5) The patient consultation shall take place in a
6    private manner consistent with rules adopted by the
7    Department of Financial and Professional Regulation.
8        (6) The Department shall adopt rules under this Section
9    that require a pharmacist to:
10            (A) complete an educational training program
11        accredited by the Accreditation Council for Pharmacy
12        Education and approved by the Department that is
13        related to the patient self-screening risk assessment,
14        patient assessment, contraceptive counseling and
15        education, and dispensation of hormonal
16        contraceptives; and
17            (B) dispense the hormonal contraceptive to the
18        patient as soon as practicable after meeting the
19        requirements of paragraph (2).
20        (7) All State and federal laws governing insurance
21    coverage of contraceptive drugs shall apply to hormonal
22    contraceptives dispensed by a pharmacist under this
23    Section.
24        (8) Nothing in this Section shall apply to any contact
25    between a pharmacist and a patient who is under age 17.
 

 

 

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1    Section 15. The Counties Code is amended by changing
2Section 5-1069.3 as follows:
 
3    (55 ILCS 5/5-1069.3)
4    Sec. 5-1069.3. Required health benefits. If a county,
5including a home rule county, is a self-insurer for purposes of
6providing health insurance coverage for its employees, the
7coverage shall include coverage for the post-mastectomy care
8benefits required to be covered by a policy of accident and
9health insurance under Section 356t and the coverage required
10under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
11356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
12356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
13356z.32, and 356z.33 of the Illinois Insurance Code. The
14coverage shall comply with Sections 155.22a, 355b, 356z.19, and
15370c of the Illinois Insurance Code. The Department of
16Insurance shall enforce the requirements of this Section. The
17requirement that health benefits be covered as provided in this
18Section is an exclusive power and function of the State and is
19a denial and limitation under Article VII, Section 6,
20subsection (h) of the Illinois Constitution. A home rule county
21to which this Section applies must comply with every provision
22of this Section.
23    Rulemaking authority to implement Public Act 95-1045, if
24any, is conditioned on the rules being adopted in accordance
25with all provisions of the Illinois Administrative Procedure

 

 

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1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
5100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
61-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
710-3-18.)
 
8    Section 20. The Illinois Municipal Code is amended by
9changing Section 10-4-2.3 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include coverage
15for the post-mastectomy care benefits required to be covered by
16a policy of accident and health insurance under Section 356t
17and the coverage required under Sections 356g, 356g.5,
18356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
20and 356z.26, and 356z.29, 356z.32, and 356z.33 of the Illinois
21Insurance Code. The coverage shall comply with Sections
22155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
23Code. The Department of Insurance shall enforce the
24requirements of this Section. The requirement that health

 

 

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1benefits be covered as provided in this is an exclusive power
2and function of the State and is a denial and limitation under
3Article VII, Section 6, subsection (h) of the Illinois
4Constitution. A home rule municipality to which this Section
5applies must comply with every provision of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
13100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
141-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1510-4-18.)
 
16    Section 25. The School Code is amended by changing Section
1710-22.3f as follows:
 
18    (105 ILCS 5/10-22.3f)
19    Sec. 10-22.3f. Required health benefits. Insurance
20protection and benefits for employees shall provide the
21post-mastectomy care benefits required to be covered by a
22policy of accident and health insurance under Section 356t and
23the coverage required under Sections 356g, 356g.5, 356g.5-1,
24356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,

 

 

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1356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
2356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
3Insurance policies shall comply with Section 356z.19 of the
4Illinois Insurance Code. The coverage shall comply with
5Sections 155.22a, 355b, and 370c of the Illinois Insurance
6Code. The Department of Insurance shall enforce the
7requirements of this Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
15100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
161-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
17    Section 30. The Illinois Insurance Code is amended by
18adding Section 356z.33 as follows:
 
19    (215 ILCS 5/356z.33 new)
20    Sec. 356z.33. Coverage for patient care services for
21hormonal contraceptives provided by a pharmacist. A group or
22individual policy of accident and health insurance or a managed
23care plan that is amended, delivered, issued, or renewed after
24the effective date of this amendatory Act of the 101st General

 

 

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1Assembly shall provide coverage for patient care services
2provided by a pharmacist for hormonal contraceptives
3assessment and consultation. Nothing in this Section shall
4mandate the coverage of patient care services provided by a
5pharmacist for hormonal contraceptives assessment and
6consultation to a patient under age 17.
 
7    Section 35. The Pharmacy Practice Act is amended by
8changing Section 3 as follows:
 
9    (225 ILCS 85/3)
10    (Section scheduled to be repealed on January 1, 2020)
11    Sec. 3. Definitions. For the purpose of this Act, except
12where otherwise limited therein:
13    (a) "Pharmacy" or "drugstore" means and includes every
14store, shop, pharmacy department, or other place where
15pharmacist care is provided by a pharmacist (1) where drugs,
16medicines, or poisons are dispensed, sold or offered for sale
17at retail, or displayed for sale at retail; or (2) where
18prescriptions of physicians, dentists, advanced practice
19registered nurses, physician assistants, veterinarians,
20podiatric physicians, or optometrists, within the limits of
21their licenses, are compounded, filled, or dispensed; or (3)
22which has upon it or displayed within it, or affixed to or used
23in connection with it, a sign bearing the word or words
24"Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical Care",

 

 

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1"Apothecary", "Drugstore", "Medicine Store", "Prescriptions",
2"Drugs", "Dispensary", "Medicines", or any word or words of
3similar or like import, either in the English language or any
4other language; or (4) where the characteristic prescription
5sign (Rx) or similar design is exhibited; or (5) any store, or
6shop, or other place with respect to which any of the above
7words, objects, signs or designs are used in any advertisement.
8    (b) "Drugs" means and includes (1) articles recognized in
9the official United States Pharmacopoeia/National Formulary
10(USP/NF), or any supplement thereto and being intended for and
11having for their main use the diagnosis, cure, mitigation,
12treatment or prevention of disease in man or other animals, as
13approved by the United States Food and Drug Administration, but
14does not include devices or their components, parts, or
15accessories; and (2) all other articles intended for and having
16for their main use the diagnosis, cure, mitigation, treatment
17or prevention of disease in man or other animals, as approved
18by the United States Food and Drug Administration, but does not
19include devices or their components, parts, or accessories; and
20(3) articles (other than food) having for their main use and
21intended to affect the structure or any function of the body of
22man or other animals; and (4) articles having for their main
23use and intended for use as a component or any articles
24specified in clause (1), (2) or (3); but does not include
25devices or their components, parts or accessories.
26    (c) "Medicines" means and includes all drugs intended for

 

 

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1human or veterinary use approved by the United States Food and
2Drug Administration.
3    (d) "Practice of pharmacy" means:
4        (1) the interpretation and the provision of assistance
5    in the monitoring, evaluation, and implementation of
6    prescription drug orders;
7        (2) the dispensing of prescription drug orders;
8        (3) participation in drug and device selection;
9        (4) drug administration limited to the administration
10    of oral, topical, injectable, and inhalation as follows:
11            (A) in the context of patient education on the
12        proper use or delivery of medications;
13            (B) vaccination of patients 14 years of age and
14        older pursuant to a valid prescription or standing
15        order, by a physician licensed to practice medicine in
16        all its branches, upon completion of appropriate
17        training, including how to address contraindications
18        and adverse reactions set forth by rule, with
19        notification to the patient's physician and
20        appropriate record retention, or pursuant to hospital
21        pharmacy and therapeutics committee policies and
22        procedures; and
23            (C) administration of injections of
24        alpha-hydroxyprogesterone caproate, pursuant to a
25        valid prescription, by a physician licensed to
26        practice medicine in all its branches, upon completion

 

 

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1        of appropriate training, including how to address
2        contraindications and adverse reactions set forth by
3        rule, with notification to the patient's physician and
4        appropriate record retention, or pursuant to hospital
5        pharmacy and therapeutics committee policies and
6        procedures;
7        (5) vaccination of patients ages 10 through 13 limited
8    to the Influenza (inactivated influenza vaccine and live
9    attenuated influenza intranasal vaccine) and Tdap (defined
10    as tetanus, diphtheria, acellular pertussis) vaccines,
11    pursuant to a valid prescription or standing order, by a
12    physician licensed to practice medicine in all its
13    branches, upon completion of appropriate training,
14    including how to address contraindications and adverse
15    reactions set forth by rule, with notification to the
16    patient's physician and appropriate record retention, or
17    pursuant to hospital pharmacy and therapeutics committee
18    policies and procedures;
19        (6) drug regimen review;
20        (7) drug or drug-related research;
21        (8) the provision of patient counseling;
22        (9) the practice of telepharmacy;
23        (10) the provision of those acts or services necessary
24    to provide pharmacist care;
25        (11) medication therapy management; and
26        (12) the responsibility for compounding and labeling

 

 

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1    of drugs and devices (except labeling by a manufacturer,
2    repackager, or distributor of non-prescription drugs and
3    commercially packaged legend drugs and devices), proper
4    and safe storage of drugs and devices, and maintenance of
5    required records; and .
6        (13) the assessment and consultation of patients and
7    dispensing of hormonal contraceptives pursuant to the
8    standing order under Section 2310-705 of the Department of
9    Public Health Powers and Duties Law of the Civil
10    Administrative Code of Illinois.
11    A pharmacist who performs any of the acts defined as the
12practice of pharmacy in this State must be actively licensed as
13a pharmacist under this Act.
14    (e) "Prescription" means and includes any written, oral,
15facsimile, or electronically transmitted order for drugs or
16medical devices, issued by a physician licensed to practice
17medicine in all its branches, dentist, veterinarian, podiatric
18physician, or optometrist, within the limits of his or her
19license, by a physician assistant in accordance with subsection
20(f) of Section 4, or by an advanced practice registered nurse
21in accordance with subsection (g) of Section 4, containing the
22following: (1) name of the patient; (2) date when prescription
23was issued; (3) name and strength of drug or description of the
24medical device prescribed; and (4) quantity; (5) directions for
25use; (6) prescriber's name, address, and signature; and (7) DEA
26registration number where required, for controlled substances.

 

 

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1The prescription may, but is not required to, list the illness,
2disease, or condition for which the drug or device is being
3prescribed. DEA registration numbers shall not be required on
4inpatient drug orders. A prescription for medication other than
5controlled substances shall be valid for up to 15 months from
6the date issued for the purpose of refills, unless the
7prescription states otherwise.
8    (f) "Person" means and includes a natural person,
9partnership, association, corporation, government entity, or
10any other legal entity.
11    (g) "Department" means the Department of Financial and
12Professional Regulation.
13    (h) "Board of Pharmacy" or "Board" means the State Board of
14Pharmacy of the Department of Financial and Professional
15Regulation.
16    (i) "Secretary" means the Secretary of Financial and
17Professional Regulation.
18    (j) "Drug product selection" means the interchange for a
19prescribed pharmaceutical product in accordance with Section
2025 of this Act and Section 3.14 of the Illinois Food, Drug and
21Cosmetic Act.
22    (k) "Inpatient drug order" means an order issued by an
23authorized prescriber for a resident or patient of a facility
24licensed under the Nursing Home Care Act, the ID/DD Community
25Care Act, the MC/DD Act, the Specialized Mental Health
26Rehabilitation Act of 2013, the Hospital Licensing Act, or the

 

 

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1University of Illinois Hospital Act, or a facility which is
2operated by the Department of Human Services (as successor to
3the Department of Mental Health and Developmental
4Disabilities) or the Department of Corrections.
5    (k-5) "Pharmacist" means an individual health care
6professional and provider currently licensed by this State to
7engage in the practice of pharmacy.
8    (l) "Pharmacist in charge" means the licensed pharmacist
9whose name appears on a pharmacy license and who is responsible
10for all aspects of the operation related to the practice of
11pharmacy.
12    (m) "Dispense" or "dispensing" means the interpretation,
13evaluation, and implementation of a prescription drug order,
14including the preparation and delivery of a drug or device to a
15patient or patient's agent in a suitable container
16appropriately labeled for subsequent administration to or use
17by a patient in accordance with applicable State and federal
18laws and regulations. "Dispense" or "dispensing" does not mean
19the physical delivery to a patient or a patient's
20representative in a home or institution by a designee of a
21pharmacist or by common carrier. "Dispense" or "dispensing"
22also does not mean the physical delivery of a drug or medical
23device to a patient or patient's representative by a
24pharmacist's designee within a pharmacy or drugstore while the
25pharmacist is on duty and the pharmacy is open.
26    (n) "Nonresident pharmacy" means a pharmacy that is located

 

 

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1in a state, commonwealth, or territory of the United States,
2other than Illinois, that delivers, dispenses, or distributes,
3through the United States Postal Service, commercially
4acceptable parcel delivery service, or other common carrier, to
5Illinois residents, any substance which requires a
6prescription.
7    (o) "Compounding" means the preparation and mixing of
8components, excluding flavorings, (1) as the result of a
9prescriber's prescription drug order or initiative based on the
10prescriber-patient-pharmacist relationship in the course of
11professional practice or (2) for the purpose of, or incident
12to, research, teaching, or chemical analysis and not for sale
13or dispensing. "Compounding" includes the preparation of drugs
14or devices in anticipation of receiving prescription drug
15orders based on routine, regularly observed dispensing
16patterns. Commercially available products may be compounded
17for dispensing to individual patients only if all of the
18following conditions are met: (i) the commercial product is not
19reasonably available from normal distribution channels in a
20timely manner to meet the patient's needs and (ii) the
21prescribing practitioner has requested that the drug be
22compounded.
23    (p) (Blank).
24    (q) (Blank).
25    (r) "Patient counseling" means the communication between a
26pharmacist or a student pharmacist under the supervision of a

 

 

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1pharmacist and a patient or the patient's representative about
2the patient's medication or device for the purpose of
3optimizing proper use of prescription medications or devices.
4"Patient counseling" may include without limitation (1)
5obtaining a medication history; (2) acquiring a patient's
6allergies and health conditions; (3) facilitation of the
7patient's understanding of the intended use of the medication;
8(4) proper directions for use; (5) significant potential
9adverse events; (6) potential food-drug interactions; and (7)
10the need to be compliant with the medication therapy. A
11pharmacy technician may only participate in the following
12aspects of patient counseling under the supervision of a
13pharmacist: (1) obtaining medication history; (2) providing
14the offer for counseling by a pharmacist or student pharmacist;
15and (3) acquiring a patient's allergies and health conditions.
16    (s) "Patient profiles" or "patient drug therapy record"
17means the obtaining, recording, and maintenance of patient
18prescription information, including prescriptions for
19controlled substances, and personal information.
20    (t) (Blank).
21    (u) "Medical device" or "device" means an instrument,
22apparatus, implement, machine, contrivance, implant, in vitro
23reagent, or other similar or related article, including any
24component part or accessory, required under federal law to bear
25the label "Caution: Federal law requires dispensing by or on
26the order of a physician". A seller of goods and services who,

 

 

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1only for the purpose of retail sales, compounds, sells, rents,
2or leases medical devices shall not, by reasons thereof, be
3required to be a licensed pharmacy.
4    (v) "Unique identifier" means an electronic signature,
5handwritten signature or initials, thumb print, or other
6acceptable biometric or electronic identification process as
7approved by the Department.
8    (w) "Current usual and customary retail price" means the
9price that a pharmacy charges to a non-third-party payor.
10    (x) "Automated pharmacy system" means a mechanical system
11located within the confines of the pharmacy or remote location
12that performs operations or activities, other than compounding
13or administration, relative to storage, packaging, dispensing,
14or distribution of medication, and which collects, controls,
15and maintains all transaction information.
16    (y) "Drug regimen review" means and includes the evaluation
17of prescription drug orders and patient records for (1) known
18allergies; (2) drug or potential therapy contraindications;
19(3) reasonable dose, duration of use, and route of
20administration, taking into consideration factors such as age,
21gender, and contraindications; (4) reasonable directions for
22use; (5) potential or actual adverse drug reactions; (6)
23drug-drug interactions; (7) drug-food interactions; (8)
24drug-disease contraindications; (9) therapeutic duplication;
25(10) patient laboratory values when authorized and available;
26(11) proper utilization (including over or under utilization)

 

 

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1and optimum therapeutic outcomes; and (12) abuse and misuse.
2    (z) "Electronically transmitted prescription" means a
3prescription that is created, recorded, or stored by electronic
4means; issued and validated with an electronic signature; and
5transmitted by electronic means directly from the prescriber to
6a pharmacy. An electronic prescription is not an image of a
7physical prescription that is transferred by electronic means
8from computer to computer, facsimile to facsimile, or facsimile
9to computer.
10    (aa) "Medication therapy management services" means a
11distinct service or group of services offered by licensed
12pharmacists, physicians licensed to practice medicine in all
13its branches, advanced practice registered nurses authorized
14in a written agreement with a physician licensed to practice
15medicine in all its branches, or physician assistants
16authorized in guidelines by a supervising physician that
17optimize therapeutic outcomes for individual patients through
18improved medication use. In a retail or other non-hospital
19pharmacy, medication therapy management services shall consist
20of the evaluation of prescription drug orders and patient
21medication records to resolve conflicts with the following:
22        (1) known allergies;
23        (2) drug or potential therapy contraindications;
24        (3) reasonable dose, duration of use, and route of
25    administration, taking into consideration factors such as
26    age, gender, and contraindications;

 

 

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1        (4) reasonable directions for use;
2        (5) potential or actual adverse drug reactions;
3        (6) drug-drug interactions;
4        (7) drug-food interactions;
5        (8) drug-disease contraindications;
6        (9) identification of therapeutic duplication;
7        (10) patient laboratory values when authorized and
8    available;
9        (11) proper utilization (including over or under
10    utilization) and optimum therapeutic outcomes; and
11        (12) drug abuse and misuse.
12    "Medication therapy management services" includes the
13following:
14        (1) documenting the services delivered and
15    communicating the information provided to patients'
16    prescribers within an appropriate time frame, not to exceed
17    48 hours;
18        (2) providing patient counseling designed to enhance a
19    patient's understanding and the appropriate use of his or
20    her medications; and
21        (3) providing information, support services, and
22    resources designed to enhance a patient's adherence with
23    his or her prescribed therapeutic regimens.
24    "Medication therapy management services" may also include
25patient care functions authorized by a physician licensed to
26practice medicine in all its branches for his or her identified

 

 

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1patient or groups of patients under specified conditions or
2limitations in a standing order from the physician.
3    "Medication therapy management services" in a licensed
4hospital may also include the following:
5        (1) reviewing assessments of the patient's health
6    status; and
7        (2) following protocols of a hospital pharmacy and
8    therapeutics committee with respect to the fulfillment of
9    medication orders.
10    (bb) "Pharmacist care" means the provision by a pharmacist
11of medication therapy management services, with or without the
12dispensing of drugs or devices, intended to achieve outcomes
13that improve patient health, quality of life, and comfort and
14enhance patient safety.
15    (cc) "Protected health information" means individually
16identifiable health information that, except as otherwise
17provided, is:
18        (1) transmitted by electronic media;
19        (2) maintained in any medium set forth in the
20    definition of "electronic media" in the federal Health
21    Insurance Portability and Accountability Act; or
22        (3) transmitted or maintained in any other form or
23    medium.
24    "Protected health information" does not include
25individually identifiable health information found in:
26        (1) education records covered by the federal Family

 

 

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1    Educational Right and Privacy Act; or
2        (2) employment records held by a licensee in its role
3    as an employer.
4    (dd) "Standing order" means a specific order for a patient
5or group of patients issued by a physician licensed to practice
6medicine in all its branches in Illinois.
7    (ee) "Address of record" means the designated address
8recorded by the Department in the applicant's application file
9or licensee's license file maintained by the Department's
10licensure maintenance unit.
11    (ff) "Home pharmacy" means the location of a pharmacy's
12primary operations.
13    (gg) "Email address of record" means the designated email
14address recorded by the Department in the applicant's
15application file or the licensee's license file, as maintained
16by the Department's licensure maintenance unit.
17(Source: P.A. 99-180, eff. 7-29-15; 100-208, eff. 1-1-18;
18100-497, eff. 9-8-17; 100-513, eff. 1-1-18; 100-804, eff.
191-1-19; 100-863, eff. 8-14-18.)
 
20    Section 40. The Illinois Public Aid Code is amended by
21adding Section 5-5.12c as follows:
 
22    (305 ILCS 5/5-5.12c new)
23    Sec. 5-5.12c. Coverage for patient care services for
24hormonal contraceptives provided by a pharmacist.

 

 

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1    (a) Subject to approval by the federal Centers for Medicare
2and Medicaid Services, the medical assistance program,
3including both the fee-for-service and managed care medical
4assistance programs established under this Article, shall
5cover patient care services provided by a pharmacist for
6hormonal contraceptives assessment and consultation for
7patients who are age 17 or older.
8    (b) The Department shall establish a fee schedule for
9patient care services provided by a pharmacist for hormonal
10contraceptives assessment and consultation.
11    (c) The rate of reimbursement for patient care services
12provided by a pharmacist for hormonal contraceptives
13assessment and consultation shall be at 85% of the fee schedule
14for physician services by the medical assistance program.
15    (d) A pharmacist must be enrolled in the medical assistance
16program as an ordering and referring provider prior to
17providing hormonal contraceptives assessment and consultation
18that is submitted by a pharmacy or pharmacist provider for
19reimbursement pursuant to this Section.
20    (e) The Director shall seek any necessary federal waivers
21or approvals to implement this Section. This Section shall not
22be implemented until the receipt of all necessary federal
23waivers or approvals or until January 1, 2022, whichever comes
24first. If federal approval is not obtained by January 1, 2022,
25the provisions of this Section shall be implemented using State
26funds.

 

 

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1    (f) This Section does not restrict or prohibit any services
2currently provided by pharmacists as authorized by law,
3including, but not limited to, pharmacist services provided
4under this Code or authorized under the Illinois Title XIX
5State Plan.
6    (g) The Department shall adopt administrative rules for
7this Section as soon as practicable but no later than May 1,
82020.
 
9    Section 95. No acceleration or delay. Where this Act makes
10changes in a statute that is represented in this Act by text
11that is not yet or no longer in effect (for example, a Section
12represented by multiple versions), the use of that text does
13not accelerate or delay the taking effect of (i) the changes
14made by this Act or (ii) provisions derived from any other
15Public Act.
 
16    Section 99. Effective date. This Act takes effect January
171, 2020.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 375/6.11
4    20 ILCS 2310/2310-705 new
5    55 ILCS 5/5-1069.3
6    65 ILCS 5/10-4-2.3
7    105 ILCS 5/10-22.3f
8    215 ILCS 5/356z.33 new
9    225 ILCS 85/3
10    305 ILCS 5/5-5.12c new