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92_HB2470eng HB2470 Engrossed LRB9201108DJgc 1 AN ACT in relation to public aid. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Illinois Public Aid Code is amended by 5 changing Section 11-26.1 and adding Section 12-4.25d as 6 follows: 7 (305 ILCS 5/11-26.1) (from Ch. 23, par. 11-26.1) 8 Sec. 11-26.1. Drug Utilization Review. 9 (a) The Illinois Department shall, within the time 10 frames mandated by federal law, implement a Drug Utilization 11 Review Program (DUR), designed to decrease overutilization of 12 drugs through both prospective and retrospective utilization 13 review. The Illinois Department shall determine the content 14 of the DUR by rule. Prescriptions filled or refilled under 15 subsection (b) of Section 12-4.25d are not subject to the 16 DUR. 17 (b) The Illinois Department may implement this Section 18 as added by this amendatory Act of 1991 through the use of 19 emergency rules in accordance with the provisions of Section 20 5.02 of the Illinois Administrative Procedure Act. For 21 purposes of the Illinois Administrative Procedure Act, the 22 adoption of rules to implement this Section as added by this 23 amendatory Act of 1991 shall be deemed an emergency and 24 necessary for the public interest, safety and welfare. 25 (Source: P.A. 87-14.) 26 (305 ILCS 5/12-4.25d new) 27 Sec. 12-4.25d. Pharmacy participation in Medicaid 28 program; prescription drug discount benefit. 29 (a) A pharmacy must comply with subsection (b) as a 30 condition of participation in the medical assistance program HB2470 Engrossed -2- LRB9201108DJgc 1 under Article V. 2 (b) If a person requests that a pharmacy fill or refill 3 a valid prescription for a prescription drug and also 4 presents the pharmacy with satisfactory proof that the person 5 for whom the prescription is written is a Medicare 6 beneficiary or a beneficiary of pharmaceutical assistance 7 under the Senior Citizens and Disabled Persons Property Tax 8 Relief and Pharmaceutical Assistance Act, the pharmacy may 9 not charge a price for filling or refilling the prescription 10 that exceeds the sum of the following: 11 (1) The pharmacy's reimbursement rate for the 12 prescription drug established by the Illinois Department 13 and applicable to prescriptions filled or refilled for 14 recipients of medical assistance under Article V. 15 (2) An amount set by the Illinois Department to 16 cover the pharmacy's costs relating to the sending or 17 receipt of electronic transmissions between the pharmacy 18 and the Illinois Department concerning reimbursement 19 rates described under paragraph (1). 20 The price restrictions described in this subsection do 21 not apply to non-prescription or over-the-counter medications 22 or to compounded prescriptions as defined in the Pharmacy 23 Practice Act of 1987. 24 (c) The Illinois Department shall establish a mechanism 25 to calculate and transmit to pharmacies the maximum prices 26 that the pharmacies may charge for filling and refilling 27 prescriptions for prescription drugs under subsection (b). 28 (d) Prescriptions filled or refilled under subsection 29 (b) are not subject to the Illinois Department's Drug 30 Utilization Review Program under Section 11-26.1. 31 (e) The Illinois Department shall monitor pharmacies' 32 compliance with this Section and shall submit a report 33 concerning that compliance to the General Assembly by April 1 34 of each year. The report shall include, but need not be HB2470 Engrossed -3- LRB9201108DJgc 1 limited to, information concerning pharmacies that 2 discontinue their participation in the medical assistance 3 program under Article V and the reasons given by those 4 pharmacies for discontinuing their participation. 5 (f) The Illinois Department shall conduct a study of its 6 pharmacy reimbursement rates under Article V, including the 7 cost of providing prescription drugs and services. The 8 Illinois Department shall report its findings to the General 9 Assembly by January 1, 2003. 10 (g) The Illinois Department shall provide consumer 11 information to all Medicare beneficiaries who reside in this 12 State and to all beneficiaries of pharmaceutical assistance 13 under the Senior Citizens and Disabled Persons Property Tax 14 Relief and Pharmaceutical Assistance Act. The information 15 must include a description of the prescription drug discount 16 benefit available under subsection (b), instructions for 17 obtaining the benefit, and prescription drug price 18 information to ensure that prescription drug discount 19 beneficiaries are aware of the maximum prices that pharmacies 20 may charge for prescription drugs under subsection (b). The 21 Illinois Department shall provide this information by 22 appropriate means, including the Internet. 23 (h) The Illinois Department shall execute interagency 24 agreements with the Department on Aging and the Department of 25 Revenue as necessary to implement subsection (g). The 26 agreements shall include provisions for assisting persons 27 entitled to the prescription drug discount benefit under 28 subsection (b) in obtaining that benefit. 29 (i) If coverage of prescription drugs is added to the 30 benefits available under the Medicare program, the Illinois 31 Department shall promptly report that fact to the General 32 Assembly. It is the General Assembly's intent that under 33 those circumstances the General Assembly shall evaluate the 34 continued implementation of this Section. HB2470 Engrossed -4- LRB9201108DJgc 1 (j) This Section is repealed on July 1, 2005.