093_SB2086
LRB093 11643 DRJ 15103 b
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 5-5.12 as follows:
6 (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
7 Sec. 5-5.12. Pharmacy payments.
8 (a) Every request submitted by a pharmacy for
9 reimbursement under this Article for prescription drugs
10 provided to a recipient of aid under this Article shall
11 include the name of the prescriber or an acceptable
12 identification number as established by the Department.
13 (b) Pharmacies providing prescription drugs under this
14 Article shall be reimbursed at a rate which shall include (i)
15 a professional dispensing fee of $5 for each generic
16 prescription drug dispensed and $4 for each brand name
17 prescription drug dispensed as determined by the Illinois
18 Department, plus (ii) the average wholesale price current
19 acquisition cost of the prescription drug dispensed minus
20 10%. The dispensing fee provided for in this subsection does
21 not include any reasonable reimbursement to a health care
22 provider for professional services (other then dispensing a
23 prescription drug) that he or she provides. The Illinois
24 Department shall update its information on the average
25 wholesale prices acquisition costs of all prescription drugs
26 no less frequently than every 30 days. However, the Illinois
27 Department may set the rate of reimbursement for the
28 acquisition cost, by rule, at a percentage of the current
29 average wholesale acquisition cost.
30 (c) Reimbursement under this Article for prescription
31 drugs shall be limited to reimbursement for 4 brand-name
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1 prescription drugs per patient per month. This subsection
2 applies only if (i) the brand-name drug was not prescribed
3 for an acute or urgent condition, (ii) the brand-name drug
4 was not prescribed for Alzheimer's disease, arthritis,
5 diabetes, HIV/AIDS, a mental health condition, or respiratory
6 disease, and (iii) a therapeutically equivalent generic
7 medication has been approved by the federal Food and Drug
8 Administration.
9 (d) The Department shall not impose requirements for
10 prior approval based on a preferred drug list for
11 anti-retroviral or any atypical antipsychotics, conventional
12 antipsychotics, or anticonvulsants used for the treatment of
13 serious mental illnesses until 30 days after it has conducted
14 a study of the impact of such requirements on patient care
15 and submitted a report to the Speaker of the House of
16 Representatives and the President of the Senate.
17 (Source: P.A. 92-597, eff. 6-28-02; 92-825, eff. 8-21-02;
18 revised 9-19-02.)
19 Section 99. Effective date. This Act takes effect upon
20 becoming law.