Sen. Michael W. Frerichs
Filed: 5/14/2009
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1 | AMENDMENT TO HOUSE BILL 152
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2 | AMENDMENT NO. ______. Amend House Bill 152 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 1. Short title. This Act may be cited as the Organ | ||||||
5 | Transplant Medication Notification Act. | ||||||
6 | Section 5. Applicability. This Act shall apply solely to | ||||||
7 | cases of immunosuppressive therapy when (i) an | ||||||
8 | immunosuppressant drug has been prescribed to a patient to | ||||||
9 | prevent the rejection of transplanted organs and
tissues and | ||||||
10 | (ii) as set forth in Section 15 of this Act, a prescribing | ||||||
11 | physician has indicated on a prescription "may not substitute". | ||||||
12 | This Act does not apply to medication orders issued for | ||||||
13 | immunosuppressant drugs for any in-patient care in a licensed | ||||||
14 | hospital. | ||||||
15 | Section 10. Definitions. For the purpose of this Act: |
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1 | "Health insurance policy or health care service plan" means | ||||||
2 | any policy of health or accident insurance subject to the | ||||||
3 | provisions of the Illinois Insurance Code, Health Maintenance | ||||||
4 | Organization Act, Voluntary Health Services Plan Act, Counties | ||||||
5 | Code, Municipal Code, School Code, and State Employees Group | ||||||
6 | Insurance Act. | ||||||
7 | "Immunosuppressant drugs" mean drugs that are used in | ||||||
8 | immunosuppressive therapy to inhibit or prevent the activity of | ||||||
9 | the immune system. "Immunosuppressant drugs" are used | ||||||
10 | clinically to prevent the rejection of transplanted organs and | ||||||
11 | tissues. "Immunosuppressant drugs" do not include drugs for the | ||||||
12 | treatment of autoimmune diseases or diseases that are most | ||||||
13 | likely of autoimmune origin. | ||||||
14 | Section 15. Quality assurance in patient care. In | ||||||
15 | accordance with the Pharmacy Practice Act, when a prescribing | ||||||
16 | physician has indicated on a prescription "may not substitute", | ||||||
17 | a health insurance policy or health care service plan that | ||||||
18 | covers immunosuppressant drugs may not require or cause a | ||||||
19 | pharmacist to interchange another immunosuppressant drug or | ||||||
20 | formulation issued on behalf of a person to inhibit or prevent | ||||||
21 | the activity of the immune system of a patient to prevent the | ||||||
22 | rejection of transplanted organs and tissues without | ||||||
23 | notification and the documented consent of the prescribing | ||||||
24 | physician and the patient, or the parent or guardian if the | ||||||
25 | patient is a child, or the spouse of a patient who is |
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1 | authorized to consent to the treatment of the person. | ||||||
2 | Except as provided by subsections (a), (b), and (c) of | ||||||
3 | Section 20 of this Act, patient co-payments, deductibles, or | ||||||
4 | other
charges for the prescribed drug for which another | ||||||
5 | immunosuppressant drug or formulation is not interchanged | ||||||
6 | shall remain the same for the enrollment period established by | ||||||
7 | the health insurance policy or plan.
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8 | Section 20. Provision of notice; formulary changes. | ||||||
9 | (a) At least 60 days prior to making any formulary change | ||||||
10 | that alters the terms of coverage for a patient receiving | ||||||
11 | immunosuppressant drugs or discontinues coverage for a | ||||||
12 | prescribed immunosuppressant drug that a patient is receiving, | ||||||
13 | a policy or plan sponsor must, to the extent possible, notify | ||||||
14 | the prescribing physician and the patient, or the parent or | ||||||
15 | guardian if the patient is a child, or the spouse of a patient | ||||||
16 | who is authorized to consent to the treatment of the patient. | ||||||
17 | The notification shall be in writing and shall disclose the | ||||||
18 | formulary change, indicate that the prescribing physician may | ||||||
19 | initiate an appeal, and include information regarding the | ||||||
20 | procedure for the prescribing physician to initiate the policy | ||||||
21 | or plan sponsor's appeal process. | ||||||
22 | (b) As an alternative to providing written notice, a policy | ||||||
23 | or plan sponsor may provide the notice electronically if, and | ||||||
24 | only if, the patient affirmatively elects to receive such | ||||||
25 | notice electronically. The notification shall disclose the |
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1 | formulary change, indicate that the prescribing physician may | ||||||
2 | initiate an appeal, and include information regarding the | ||||||
3 | procedure for the prescribing physician to initiate the policy | ||||||
4 | or plan sponsor's appeal process. | ||||||
5 | (c) At the time a patient requests a refill of the | ||||||
6 | immunosuppressant drug, a policy or plan sponsor may provide | ||||||
7 | the patient with the written notification required under | ||||||
8 | subsection (a) of this Section along with a 60-day supply of | ||||||
9 | the immunosuppressant drug under the same terms as previously | ||||||
10 | allowed. | ||||||
11 | (d) Nothing in this Section shall prohibit insurers or | ||||||
12 | pharmacy benefit managers from using managed pharmacy care | ||||||
13 | tools, including, but not limited to, formulary tiers, generic | ||||||
14 | substitution, therapeutic interchange, prior authorization, or | ||||||
15 | step therapy, so long as an exception process is in place | ||||||
16 | allowing the prescriber to petition for coverage of a | ||||||
17 | non-preferred drug if sufficient clinical reasons justify an | ||||||
18 | exception to the normal protocol.".
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