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| [ House Amendment 001 ] |
91_HB3117
LRB9111189JSpc
1 AN ACT to amend the Managed Care Reform and Patient
2 Rights Act by changing Section 72.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Managed Care Reform and Patient Rights
6 Act is amended by changing Section 72 as follows:
7 (215 ILCS 134/72)
8 Sec. 72. Pharmacy providers.
9 (a) Before entering into an agreement with pharmacy
10 providers, a health care plan must establish terms and
11 conditions that must be met by pharmacy providers desiring to
12 contract with the health care plan. The terms and conditions
13 shall not discriminate against a pharmacy provider. A health
14 care plan may not refuse to contract with a pharmacy provider
15 that meets the terms and conditions established by the health
16 care plan. If a pharmacy provider rejects the terms and
17 conditions established, the health care plan may offer other
18 terms and conditions necessary to comply with network
19 adequacy requirements.
20 (b) A health care plan shall apply the same
21 co-insurance, copayment, and deductible factors to all drug
22 prescriptions filled by a pharmacy provider that participates
23 in the health care plan's network. Nothing in this
24 subsection, however, prohibits a health care plan from
25 applying different co-insurance, copayment, and deductible
26 factors between brand name drugs and generic drugs when a
27 generic equivalent exists for the brand name drug.
28 (c) A health care plan may not set a limit on the
29 quantity of drugs that an enrollee may obtain at one time
30 with a prescription unless the limit is applied uniformly to
31 all pharmacy providers in the health care plan's network.
-2- LRB9111189JSpc
1 (d) If a health care plan requires confirmation of
2 pharmaceutical benefits before a prescription is filled, the
3 plan shall provide or require the pharmacy provider to
4 provide access 24 hours a day, 7 days a week to persons
5 designated by the plan to confirm benefits.
6 (Source: P.A. 91-617, eff. 1-1-00.)