Public Act 93-0106

HB0703 Enrolled                      LRB093 05492 MKM 05583 b

    AN ACT in relation to public aid.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.   The  Illinois Public Aid Code is amended by
changing Section 5-5.12 as follows:

    (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
    Sec. 5-5.12.  Pharmacy payments.
    (a)  Every  request   submitted   by   a   pharmacy   for
reimbursement  under  this  Article  for  prescription  drugs
provided  to  a  recipient  of  aid  under this Article shall
include  the  name  of  the  prescriber  or   an   acceptable
identification number as established by the Department.
    (b)  Pharmacies  providing  prescription drugs under this
Article shall be reimbursed at a rate which shall  include  a
professional  dispensing  fee  as  determined by the Illinois
Department,  plus  the  current  acquisition  cost   of   the
prescription  drug  dispensed.  The Illinois Department shall
update its  information  on  the  acquisition  costs  of  all
prescription  drugs  no  less  frequently than every 30 days.
However,  the  Illinois  Department  may  set  the  rate   of
reimbursement  for  the  acquisition  cost,  by  rule,  at  a
percentage of the current average wholesale acquisition cost.
    (c)  Reimbursement  under  this  Article for prescription
drugs shall be limited  to  reimbursement  for  4  brand-name
prescription  drugs  per  patient per month.  This subsection
applies only if (i) the brand-name drug  was  not  prescribed
for  an  acute  or urgent condition, (ii) the brand-name drug
was  not  prescribed  for  Alzheimer's  disease,   arthritis,
diabetes, HIV/AIDS, a mental health condition, or respiratory
disease,  and  (iii)  a  therapeutically  equivalent  generic
medication  has  been  approved  by the federal Food and Drug
Administration.
    (d)  The Department shall  not  impose  requirements  for
prior   approval   based   on   a  preferred  drug  list  for
anti-retroviral, anti-hemophilic factor concentrates, or  any
atypical   antipsychotics,  conventional  antipsychotics,  or
anticonvulsants used for  the  treatment  of  serious  mental
illnesses until 30 days after it has conducted a study of the
impact  of  such requirements on patient care and submitted a
report to the Speaker of the House of Representatives and the
President of the Senate.
(Source: P.A. 92-597, eff.  6-28-02;  92-825,  eff.  8-21-02;
revised 9-19-02.)

    Section  99.  Effective date.  This Act takes effect upon
becoming law.

Effective Date: 07/08/03