Sen. David Koehler
Filed: 3/22/2012
 
 

 

 

 
09700SB3213sam002LRB097 19090 KTG 66840 a



1
AMENDMENT TO SENATE BILL 3213




2    AMENDMENT NO. ______. Amend Senate Bill 3213 by replacing 
3everything after the enacting clause with the following:

 
 
4    "Section 5. The Illinois Public Aid Code is amended  by 
5changing 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 reimbursement 
9under this
Article for prescription drugs provided to a 
10recipient of aid under this
Article shall include the name of 
11the prescriber or an acceptable
identification number as 
12established by the Department.

13    (b) Pharmacies providing prescription drugs under
this 
14Article shall be reimbursed at a rate which shall include
a 
15professional dispensing fee as determined by the Illinois

16Department, plus the current acquisition cost of the 
 
 
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1prescription
drug dispensed. The Illinois Department shall 
2update its
information on the acquisition costs of all 
3prescription drugs
no less frequently than every 30 days. 
4However, the Illinois
Department may set the rate of 
5reimbursement for the acquisition
cost, by rule, at a 
6percentage of the current average wholesale
acquisition cost.

7    (c) (Blank).

8    (d) The Department shall not impose requirements for prior 
9approval
based on a preferred drug list for anti-retroviral, 
10anti-hemophilic factor
concentrates,
or
any atypical 
11antipsychotics, conventional antipsychotics,
or 
12anticonvulsants used for the treatment of serious mental

13illnesses
until 30 days after it has conducted a study of the 
14impact of such
requirements on patient care and submitted a 
15report to the Speaker of the
House of Representatives and the 
16President of the Senate. The Department shall review 
17utilization of narcotic medications in the medical assistance 
18program and impose utilization controls that protect against 
19abuse. 

20    (e) When making determinations as to which drugs shall be  
21on a prior approval list, the Department shall include as part 
22of the analysis for this determination, the degree to which a 
23drug may affect individuals in different ways based on factors 
24including the gender of the person taking the medication. 
25    (f) The Department shall cooperate with the Department of 
26Public Health and the Department of Human Services Division of 
 
 
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1Mental Health in identifying psychotropic medications that, 
2when given in a particular form, manner, duration, or frequency 
3(including "as needed") in a dosage, or in conjunction with 
4other psychotropic medications to a nursing home resident or to 
5a resident of a facility licensed under the ID/DD MR/DD 
6Community Care Act, may constitute a chemical restraint or an 
7"unnecessary drug" as defined by the Nursing Home Care Act or 
8Titles XVIII and XIX of the Social Security Act and the 
9implementing rules and regulations.  The Department shall 
10require prior approval for any such medication prescribed for a 
11nursing home resident or to a resident of a facility licensed 
12under the ID/DD MR/DD Community Care Act, that appears to be a 
13chemical restraint or an unnecessary drug.  The Department shall 
14consult with the Department of Human Services Division of 
15Mental Health in developing a protocol and criteria for 
16deciding whether to grant such prior approval. 
17    (g) The Department may by rule provide for reimbursement of 
18the dispensing of a 90-day supply of a generic or brand name, 
19non-narcotic maintenance medication in circumstances where it 
20is cost effective. 
21    (h) Effective July 1, 2011, the Department shall 
22discontinue coverage of select over-the-counter drugs, 
23including analgesics and cough and cold  and allergy 
24medications. 
25    (i) The Department shall develop a program of utilization 
26review and control for specialty drugs seek any necessary 
 
 
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1waiver from the federal government in order to establish a 
2program limiting the pharmacies eligible to dispense specialty 
3drugs and shall issue a Request for Proposals in order to 
4maximize savings on these drugs. The Department shall by rule 
5establish the drugs required to be dispensed in this program. 
6(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; 
796-1501, eff. 1-25-11; 97-38, eff. 6-28-11; 97-74, eff. 
86-30-11; 97-333, eff. 8-12-11; 97-426, eff. 1-1-12; revised 
910-4-11.)

  
 

10    Section 99. Effective date. This Act takes effect upon 
11becoming law.".