93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4970


 
Introduced 02/05/04, by Rosemary Mulligan
 
SYNOPSIS AS INTRODUCED:
 		













305 ILCS 5/5-5.12
  from Ch. 23, par. 5-5.12








    Amends the Illinois Public Aid Code.  Makes technical changes in a
Section concerning pharmacy payments under the Medicaid program.
















LRB093 18795 DRJ 44529 b

















 


 


A BILL FOR









 











HB4970

LRB093 18795 DRJ 44529 b






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    AN ACT in relation to public aid. 

 
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    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 
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changing
Section 5-5.12 as follows:


 



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    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)


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    Sec. 5-5.12. Pharmacy payments. 

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    (a) Every request submitted by a pharmacy for reimbursement 
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under this
Article for prescription drugs provided to a 
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recipient of aid under this
Article shall include the name of 
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the prescriber or an acceptable
identification number as 
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established by the Illinois Department.

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    (b) Pharmacies providing prescription drugs under
this 
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Article shall be reimbursed at a rate that includes
which shall 
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include
a professional dispensing fee as determined by the 
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Illinois
Department, plus the current acquisition cost of the 
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prescription
drug dispensed. The Illinois Department shall 
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update its
information on the acquisition costs of all 
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prescription drugs
no less frequently than every 30 days. 
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However, the Illinois
Department may set the rate of 
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reimbursement for the acquisition
cost, by rule, at a 
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percentage of the current average wholesale
acquisition cost.

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    (c) Reimbursement under this Article for prescription 
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drugs shall be
limited to reimbursement for 4 brand-name 
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prescription drugs per patient per
month.  This subsection 
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applies only if (i) the brand-name drug was not
prescribed for 
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an acute or urgent condition, (ii) the brand-name drug was not

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prescribed for Alzheimer's disease, arthritis, diabetes, 
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HIV/AIDS, a mental
health condition, or respiratory disease, 
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and (iii) a therapeutically
equivalent generic medication has 
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been approved by the federal Food and Drug
Administration.

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    (d) The Department shall not impose requirements for prior 
 


 






HB4970
- 2 -
LRB093 18795 DRJ 44529 b




1
approval
based on a preferred drug list for anti-retroviral, 
2
anti-hemophilic factor
concentrates,
or
any atypical 
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antipsychotics, conventional antipsychotics,
or 
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anticonvulsants used for the treatment of serious mental

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illnesses
until 30 days after it has conducted a study of the 
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impact of such
requirements on patient care and submitted a 
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report to the Speaker of the
House of Representatives and the 
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President of the Senate.

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(Source: P.A. 92-597, eff. 6-28-02; 92-825, eff. 8-21-02; 
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93-106, eff.
7-8-03.)