Sen. Debbie DeFrancesco Halvorson

Filed: 2/25/2004

 

 


 

 


 
09300SB3155sam001 LRB093 19814 AMC 47896 a

1
AMENDMENT TO SENATE BILL 3155

2     AMENDMENT NO. ______. Amend Senate Bill 3155 by replacing
3 everything after the enacting clause with the following:
 
4     "Section 5. The Senior Citizens and Disabled Persons
5 Prescription Drug Discount Program Act is amended by changing
6 Section 25 as follows:
 
7     (320 ILCS 55/25)
8     Sec. 25. Program administration.
9     (a) The Department is authorized under this Act to be the
10 program administrator. If the Department is not the program
11 administrator, 90 days after the effective date of this Act,
12 the Department must issue a request for proposals for bidders
13 interested in administering the program. Bidders must compete
14 on the basis of the following minimum criteria:
15         (1) The Director shall solicit and accept proposals
16 from entities to provide for administration of a program or
17 programs in accordance with rules adopted under Section 45.
18 Proposals must be submitted not later than a date
19 established by the Director. The Director shall accept only
20 those proposals that specify the following:
21             (A) The estimated amount of the discount based on
22 the entity's previous experience and how the discount
23 is to be achieved.
24             (B) The extent that discounts on prescription

 

 

09300SB3155sam001 - 2 - LRB093 19814 AMC 47896 a

1 drugs are to be achieved through rebates,
2 administrative fees, or other fees or discounts in
3 prices that the entity negotiates with drug
4 manufacturers. The proposals shall assure that rebates
5 or discounts will be used to do the following:
6                 (i) reduce costs to cardholders;
7                 (ii) achieve discounts for cardholders; and
8                 (iii) cover costs for administering the
9 program.
10             (C) Any other benefits offered to cardholders.
11             (D) The estimated number and geographic
12 distribution of participating pharmacies in the
13 administrator's pharmacy network.
14             (E) The plan for pharmacy compensation, pursuant
15 to subsection (e) of this Section.
16             (F) The method used for determining the
17 prescription drugs to be covered by the program,
18 including the criteria and process for establishing a
19 preferred drug list, if applicable.
20             (G) How the entity proposes to improve medication
21 management for cardholders, including any program of
22 disease management.
23             (H) How cardholders and participating pharmacies
24 will be informed of the discounted price negotiated by
25 the entity.
26             (I) How the entity will handle complaints about the
27 program's operation.
28             (J) The entity's previous experience in managing
29 similar programs.
30             (K) Any additional information requested by the
31 Director.
32         (2) The Director shall contract with one or more
33 entities to administer a program or programs on the basis
34 of the proposals submitted, but may require an

 

 

09300SB3155sam001 - 3 - LRB093 19814 AMC 47896 a

1 administrator to modify its conduct of a program in
2 accordance with rules adopted under Section 45.
3         The Director shall adopt rules specifying the period
4 for which a contract will be in effect and may terminate a
5 contract if an administrator fails to conduct a program in
6 accordance with its proposal or with any modifications
7 required by rule. When a contract period ends or a contract
8 is terminated, the Director shall enter into a new contract
9 in the manner specified in this Section for an original
10 contract. Prior to making a new contract, the Director may
11 modify the rules for administration of the program or
12 programs.
13     (b) As used in this Section, "administrator" includes the
14 administrator's parent company and any subsidiary of the parent
15 company.
16         (1) No administrator shall sell any information
17 concerning a person who holds a prescription drug discount
18 card, other than aggregate information that does not
19 identify the cardholder, without the cardholder's written
20 consent.
21         (2) Unless an administrator has the cardholder's
22 written consent, no administrator shall use any personally
23 identifiable information that it obtains concerning a
24 cardholder through the program to promote or sell a program
25 or product offered by the administrator that is not related
26 to the administration of the program. This subsection (b)
27 does not prohibit an administrator from contacting
28 cardholders concerning participation in or administration
29 of the program, including, but not limited to, mailing a
30 list of pharmacies participating in the program's network
31 or participating in disease management programs.
32         (3) To the extent that a discount is achieved through
33 rebates, administrative fees, or any other fees or
34 discounts in prices that an administrator negotiates with

 

 

09300SB3155sam001 - 4 - LRB093 19814 AMC 47896 a

1 drug manufacturers, an administrator shall use the rebates
2 or discounts to do the following:
3             (A) reduce costs to cardholders;
4             (B) achieve discounts for cardholders; and
5             (C) cover any administrative costs of the program.
6         (4) The administrator shall not use any funds generated
7 from rebates, discounts, administrative fees, or other
8 fees to promote its mail order pharmacy operation or the
9 mail order pharmacy operation of an affiliate. This
10 subdivision (b)(4) does not, however, limit the
11 participation of an Illinois-licensed pharmacy under this
12 Act if that pharmacy provides prescription drugs by mail
13 order.
14     (c) Beginning on January 1, 2004 and until the effective
15 date of this amendatory Act of the 93rd General Assembly, the
16 amount paid by eligible seniors and disabled persons enrolled
17 in the program to authorized pharmacies for prescription drugs
18 may not exceed prices established as a result of the rebate
19 agreements under Section 30. The eligible seniors and disabled
20 persons shall pay the price determined under Section 30 plus a
21 dispensing fee of $3.50 per prescription for brand name drug
22 products, single-source drug products, and, for a period of 6
23 months, newly released generic drug products and $4.25 per
24 prescription for all other generic drug products, except that
25 the total amount paid by the eligible senior or disabled person
26 for each prescription drug under this program shall not exceed
27 the usual and customary charge for such prescription.
28     (c-5) Beginning on the effective date of this amendatory
29 Act of the 93rd General Assembly, the amount paid by eligible
30 seniors and disabled persons enrolled in the program to
31 authorized pharmacies for prescription drugs may not exceed
32 amounts agreed upon between the Department or the program
33 administrator and the participating pharmacy. The eligible
34 seniors and disabled persons shall pay the lesser of the amount

 

 

09300SB3155sam001 - 5 - LRB093 19814 AMC 47896 a

1 agreed upon or the usual and customary charge for such
2 prescription.
3     (d) The contract between the Department and a pharmacy
4 benefits manager must, at a minimum, meet the criteria of
5 subsection (a). The contract must also require notification by
6 the pharmacy benefits manager of any proposed or ongoing
7 activity that involves, directly or indirectly, any conflict of
8 interest on the part of the pharmacy benefits manager. The
9 Department shall ensure that the pharmacy benefits manager
10 complies with the contract and shall adopt all procedures
11 necessary to enforce the contract.
12     (e) (Blank). The Department or program administrator
13 shall, subject to the funds available under Section 30 of this
14 Act, compensate authorized pharmacies for prescription drugs
15 dispensed under the program for the difference between the
16 amount paid by the eligible senior or disabled person for
17 prescription drugs dispensed under the program and (i) the AWP
18 minus 12% for brand name drug products, single-source generic
19 drug products, and, for a period of 6 months, newly released
20 generic drug products and (ii) the AWP minus 35% for all other
21 generic drug products. The Department shall compensate a
22 pharmacy under this subsection (e) only if the amount paid by
23 the eligible senior or disabled person has been discounted to a
24 price, including the dispensing fees stated in subsection (c)
25 of this Section, that is less than (i) the AWP minus 12% for
26 brand name drug products, single-source generic drug products,
27 and, for a period of 6 months, newly released generic drug
28 products and (ii) the AWP minus 35% for all other generic drug
29 products.
30     (f) Beginning on January 1, 2004, the Department or program
31 administrator shall reimburse pharmacies under this Section
32 within 30 days after adjudication of the claim for claims made
33 based on prescription drugs dispensed under the program before
34 the effective date of this amendatory Act of the 93rd General

 

 

09300SB3155sam001 - 6 - LRB093 19814 AMC 47896 a

1 Assembly..
2 (Source: P.A. 93-18, eff. 7-1-03.)
 
3     Section 99. Effective date. This Act takes effect upon
4 becoming law.".