Illinois General Assembly - Bill Status for HB4096

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall require each Medicaid Managed Care Organization to list as preferred on the Medicaid Managed Care Organization's preferred drug list every pharmaceutical that is listed as preferred on the Department's preferred drug list. Provides that the Department shall not prohibit, or adopt any rules or policies that prohibit, a Medicaid Managed Care Organization from: (i) covering additional pharmaceuticals that are not listed on the Department's preferred drug list; or (ii) removing from the Medicaid Managed Care Organization's preferred drug list any prior approval requirements applicable under the Department's preferred drug list. Provides that the Department shall not require a Medicaid Managed Care Organization to utilize a single, statewide preferred drug list and shall not prohibit a plan from negotiating drug pricing concessions or rebates on any drug with pharmaceutical companies, unless otherwise required by federal law. Provides that no later than July 1, 2018, the Department shall develop a standardized format for all Medicaid Managed Care Organization preferred drug lists in cooperation with Medicaid Managed Care Organizations and stakeholders, including, but not limited to, community-based organizations, providers, and individuals or entities with expertise in drug formulary development. Requires each Medicaid Managed Care Organization to post its preferred drug list on its website without restricting access to enrolled members and to update the preferred drug list posted on its website within 2 business days of making any changes to the preferred drug list, including, but not limited to, any and all changes to requirements for prior approval. Effective immediately.

Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires Medicaid managed care organizations (rather than managed care entities) that provide services under the Code to use a pharmacy formulary that is no more restrictive by drug class than the Department of Healthcare and Family Services' preferred drug list (rather than the Department's pharmaceutical program). Provides that beginning January 1, 2019 and continuing through January 1, 2022, the Department shall require each Medicaid managed care organization to list as preferred on the Medicaid managed care organization's preferred drug list at least the same number, and no fewer, of drugs per drug class as are listed on the Department's preferred drug list. Prohibits the Department from adopting any rules or policies that prohibit a Medicaid managed care organization from: (1) covering additional drugs that are not listed on the Department's preferred drug list; (2) submitting all covered drugs listed on the Department's preferred drug list and additional drugs covered by the Medicaid managed care organization as qualified encounters to be used for appropriate purposes; or (3) removing from the Medicaid managed care organization's preferred drug list any prior approval requirements, step therapy, or other utilization controls applicable under the Department's preferred drug list. Requires the Department to develop a standardized format for all Medicaid managed care organization preferred drug lists by January 1, 2019 and to allow Medicaid managed care organizations 6 months from the completion date of the standardized format to comply with the new Preferred Drug List format. Requires each Medicaid managed care organization to post its preferred drug list on its website without restricting access and to update the preferred drug list posted on its website no less than 30 days prior to the date upon which any update or change takes effect. Requires the Department to establish, no later than January 1, 2019, the Illinois Pharmacy and Therapeutics Advisory Board to have the authority and responsibility to provide recommendations to the Department regarding which drug products to list on the Department's preferred drug list. Contains provisions concerning Board meetings and correspondence; the Board's composition; voting and non-voting members; and other matters. Requires the Department to adopt rules, to be in place no later than January 1, 2019, for the purpose of establishing and maintaining the Board. Effective immediately.

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