101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB1442

 

Introduced , by Rep. Michelle Mussman

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Provides that the Director of Public Health, if a physician licensed to practice medicine in all its branches in Illinois, shall establish a standing order complete with the issuance of a prescription for a hormonal contraceptive in accordance with the requirements of the provisions. Provides that if the Director is not a physician licensed to practice medicine in all its branches in Illinois, the Medical Director of the Department of Public Health shall establish the standing order. Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or managed care plan to provide coverage for patient care services provided by a pharmacist. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code. Amends the Pharmacy Practice Act. Provides that the definition of "practice of pharmacy" includes the dispensing of hormonal contraceptives pursuant to the standing order under provisions of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Amends the Illinois Public Aid Code. Requires the medical assistance program to cover patient care services provided by a pharmacist for hormonal contraceptives assessment and consultation. Effective January 1, 2020.


LRB101 04917 SMS 49926 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB1442LRB101 04917 SMS 49926 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 100-1170)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and
17356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
18The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
20Illinois Insurance Code. The Department of Insurance shall
21enforce the requirements of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
71-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
81-8-19.)
 
9    (Text of Section after amendment by P.A. 100-1170)
10    Sec. 6.11. Required health benefits; Illinois Insurance
11Code requirements. The program of health benefits shall provide
12the post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t of
14the Illinois Insurance Code. The program of health benefits
15shall provide the coverage required under Sections 356g,
16356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
19and 356z.32, and 356z.33 of the Illinois Insurance Code. The
20program of health benefits must comply with Sections 155.22a,
21155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
22Insurance Code. The Department of Insurance shall enforce the
23requirements of this Section with respect to Sections 370c and
24370c.1 of the Illinois Insurance Code; all other requirements
25of this Section shall be enforced by the Department of Central

 

 

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1Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
9100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
101-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
11100-1170, eff. 6-1-19.)
 
12    Section 10. The Department of Public Health Powers and
13Duties Law of the Civil Administrative Code of Illinois is
14amended by adding Section 2310-705 as follows:
 
15    (20 ILCS 2310/2310-705 new)
16    Sec. 2310-705. Contraceptive drugs and products; Director
17standing order.
18    (a) As used in this Section:
19    "Hormonal contraceptive" means a prescribed
20medically-acceptable oral drug, transdermal patch, or vaginal
21ring that is approved by the United States Food and Drug
22Administration to prevent pregnancy.
23    "Standing order" has the meaning given to that term in the
24Pharmacy Practice Act.

 

 

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1    (b) If the Director of Public Health is a physician
2licensed to practice medicine in all its branches in Illinois,
3the Director shall establish a standing order complete with the
4issuance of a prescription for a hormonal contraceptive in
5accordance with this Section. If the Director is not a
6physician licensed to practice medicine in all its branches in
7Illinois, then the Medical Director of the Department of Public
8Health shall establish a standing order in accordance with this
9Section.
10    (c) The standing order, at a minimum, shall comply with the
11following:
12        (1) A pharmacist may dispense a 12-month supply of
13    hormonal contraceptives to a patient.
14        (2) A pharmacist shall have the patient complete the
15    self-screening risk assessment tool. The self-screening
16    risk assessment tool is to be based on the most current
17    version of the United States Medical Eligibility Criteria
18    for Contraceptive Use published by the federal Centers for
19    Disease Control and Prevention.
20        (3) Based upon the results of the self-screening risk
21    assessment and the patient assessment, the pharmacist
22    shall use his or her professional and clinical judgment as
23    to when a patient should be referred to the patient's
24    physician or another health care provider.
25        (4) The pharmacist shall provide, during the patient
26    assessment and consultation, counseling and education

 

 

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1    about all methods of contraception, including methods not
2    covered under the standing order, and their proper use and
3    effectiveness.
4        (5) The patient consultation shall take place in a
5    private manner consistent with rules adopted by the
6    Department of Financial and Professional Regulation.
7        (6) The Department shall adopt rules under this Section
8    that require a pharmacist to:
9            (A) complete an educational training program
10        accredited by the Accreditation Council for Pharmacy
11        Education and approved by the Department that is
12        related to the patient self-screening risk assessment,
13        patient assessment, contraceptive counseling and
14        education, and dispensation of hormonal
15        contraceptives; and
16            (B) dispense the hormonal contraceptive to the
17        patient as soon as practicable after meeting the
18        requirements of paragraph (2).
19        (7) All State and federal laws governing insurance
20    coverage of contraceptive drugs shall apply to hormonal
21    contraceptives dispensed by a pharmacist under this
22    Section.
 
23    Section 15. The Counties Code is amended by changing
24Section 5-1069.3 as follows:
 

 

 

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1    (55 ILCS 5/5-1069.3)
2    Sec. 5-1069.3. Required health benefits. If a county,
3including a home rule county, is a self-insurer for purposes of
4providing health insurance coverage for its employees, the
5coverage shall include coverage for the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
9356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
10356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
11356z.32, and 356z.33 of the Illinois Insurance Code. The
12coverage shall comply with Sections 155.22a, 355b, 356z.19, and
13370c of the Illinois Insurance Code. The Department of
14Insurance shall enforce the requirements of this Section. The
15requirement that health benefits be covered as provided in this
16Section is an exclusive power and function of the State and is
17a denial and limitation under Article VII, Section 6,
18subsection (h) of the Illinois Constitution. A home rule county
19to which this Section applies must comply with every provision
20of this Section.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for
26whatever reason, is unauthorized.

 

 

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1(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
2100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
31-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
410-3-18.)
 
5    Section 20. The Illinois Municipal Code is amended by
6changing Section 10-4-2.3 as follows:
 
7    (65 ILCS 5/10-4-2.3)
8    Sec. 10-4-2.3. Required health benefits. If a
9municipality, including a home rule municipality, is a
10self-insurer for purposes of providing health insurance
11coverage for its employees, the coverage shall include coverage
12for the post-mastectomy care benefits required to be covered by
13a policy of accident and health insurance under Section 356t
14and the coverage required under Sections 356g, 356g.5,
15356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
17and 356z.26, and 356z.29, 356z.32, and 356z.33 of the Illinois
18Insurance Code. The coverage shall comply with Sections
19155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
20Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this is an exclusive power
23and function of the State and is a denial and limitation under
24Article VII, Section 6, subsection (h) of the Illinois

 

 

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1Constitution. A home rule municipality to which this Section
2applies must comply with every provision of this Section.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
10100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
111-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1210-4-18.)
 
13    Section 25. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
22356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
23356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
24Insurance policies shall comply with Section 356z.19 of the

 

 

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1Illinois Insurance Code. The coverage shall comply with
2Sections 155.22a, 355b, and 370c of the Illinois Insurance
3Code. The Department of Insurance shall enforce the
4requirements of this Section.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
12100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
131-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
14    Section 30. The Illinois Insurance Code is amended by
15adding Section 356z.33 as follows:
 
16    (215 ILCS 5/356z.33 new)
17    Sec. 356z.33. Coverage for patient care services for
18hormonal contraceptives provided by a pharmacist. A group or
19individual policy of accident and health insurance or a managed
20care plan that is amended, delivered, issued, or renewed after
21the effective date of this amendatory Act of the 101st General
22Assembly shall provide coverage for patient care services
23provided by a pharmacist for hormonal contraceptives
24assessment and consultation.
 

 

 

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1    Section 35. The Pharmacy Practice Act is amended by
2changing Section 3 as follows:
 
3    (225 ILCS 85/3)
4    (Section scheduled to be repealed on January 1, 2020)
5    Sec. 3. Definitions. For the purpose of this Act, except
6where otherwise limited therein:
7    (a) "Pharmacy" or "drugstore" means and includes every
8store, shop, pharmacy department, or other place where
9pharmacist care is provided by a pharmacist (1) where drugs,
10medicines, or poisons are dispensed, sold or offered for sale
11at retail, or displayed for sale at retail; or (2) where
12prescriptions of physicians, dentists, advanced practice
13registered nurses, physician assistants, veterinarians,
14podiatric physicians, or optometrists, within the limits of
15their licenses, are compounded, filled, or dispensed; or (3)
16which has upon it or displayed within it, or affixed to or used
17in connection with it, a sign bearing the word or words
18"Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical Care",
19"Apothecary", "Drugstore", "Medicine Store", "Prescriptions",
20"Drugs", "Dispensary", "Medicines", or any word or words of
21similar or like import, either in the English language or any
22other language; or (4) where the characteristic prescription
23sign (Rx) or similar design is exhibited; or (5) any store, or
24shop, or other place with respect to which any of the above

 

 

HB1442- 11 -LRB101 04917 SMS 49926 b

1words, objects, signs or designs are used in any advertisement.
2    (b) "Drugs" means and includes (1) articles recognized in
3the official United States Pharmacopoeia/National Formulary
4(USP/NF), or any supplement thereto and being intended for and
5having for their main use the diagnosis, cure, mitigation,
6treatment or prevention of disease in man or other animals, as
7approved by the United States Food and Drug Administration, but
8does not include devices or their components, parts, or
9accessories; and (2) all other articles intended for and having
10for their main use the diagnosis, cure, mitigation, treatment
11or prevention of disease in man or other animals, as approved
12by the United States Food and Drug Administration, but does not
13include devices or their components, parts, or accessories; and
14(3) articles (other than food) having for their main use and
15intended to affect the structure or any function of the body of
16man or other animals; and (4) articles having for their main
17use and intended for use as a component or any articles
18specified in clause (1), (2) or (3); but does not include
19devices or their components, parts or accessories.
20    (c) "Medicines" means and includes all drugs intended for
21human or veterinary use approved by the United States Food and
22Drug Administration.
23    (d) "Practice of pharmacy" means:
24        (1) the interpretation and the provision of assistance
25    in the monitoring, evaluation, and implementation of
26    prescription drug orders;

 

 

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1        (2) the dispensing of prescription drug orders;
2        (3) participation in drug and device selection;
3        (4) drug administration limited to the administration
4    of oral, topical, injectable, and inhalation as follows:
5            (A) in the context of patient education on the
6        proper use or delivery of medications;
7            (B) vaccination of patients 14 years of age and
8        older pursuant to a valid prescription or standing
9        order, by a physician licensed to practice medicine in
10        all its branches, upon completion of appropriate
11        training, including how to address contraindications
12        and adverse reactions set forth by rule, with
13        notification to the patient's physician and
14        appropriate record retention, or pursuant to hospital
15        pharmacy and therapeutics committee policies and
16        procedures; and
17            (C) administration of injections of
18        alpha-hydroxyprogesterone caproate, pursuant to a
19        valid prescription, by a physician licensed to
20        practice medicine in all its branches, upon completion
21        of appropriate training, including how to address
22        contraindications and adverse reactions set forth by
23        rule, with notification to the patient's physician and
24        appropriate record retention, or pursuant to hospital
25        pharmacy and therapeutics committee policies and
26        procedures;

 

 

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1        (5) vaccination of patients ages 10 through 13 limited
2    to the Influenza (inactivated influenza vaccine and live
3    attenuated influenza intranasal vaccine) and Tdap (defined
4    as tetanus, diphtheria, acellular pertussis) vaccines,
5    pursuant to a valid prescription or standing order, by a
6    physician licensed to practice medicine in all its
7    branches, upon completion of appropriate training,
8    including how to address contraindications and adverse
9    reactions set forth by rule, with notification to the
10    patient's physician and appropriate record retention, or
11    pursuant to hospital pharmacy and therapeutics committee
12    policies and procedures;
13        (6) drug regimen review;
14        (7) drug or drug-related research;
15        (8) the provision of patient counseling;
16        (9) the practice of telepharmacy;
17        (10) the provision of those acts or services necessary
18    to provide pharmacist care;
19        (11) medication therapy management; and
20        (12) the responsibility for compounding and labeling
21    of drugs and devices (except labeling by a manufacturer,
22    repackager, or distributor of non-prescription drugs and
23    commercially packaged legend drugs and devices), proper
24    and safe storage of drugs and devices, and maintenance of
25    required records; and .
26        (13) the assessment and consultation of patients and

 

 

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1    dispensing of hormonal contraceptives pursuant to the
2    standing order under Section 2310-705 of the Department of
3    Public Health Powers and Duties Law of the Civil
4    Administrative Code of Illinois.
5    A pharmacist who performs any of the acts defined as the
6practice of pharmacy in this State must be actively licensed as
7a pharmacist under this Act.
8    (e) "Prescription" means and includes any written, oral,
9facsimile, or electronically transmitted order for drugs or
10medical devices, issued by a physician licensed to practice
11medicine in all its branches, dentist, veterinarian, podiatric
12physician, or optometrist, within the limits of his or her
13license, by a physician assistant in accordance with subsection
14(f) of Section 4, or by an advanced practice registered nurse
15in accordance with subsection (g) of Section 4, containing the
16following: (1) name of the patient; (2) date when prescription
17was issued; (3) name and strength of drug or description of the
18medical device prescribed; and (4) quantity; (5) directions for
19use; (6) prescriber's name, address, and signature; and (7) DEA
20registration number where required, for controlled substances.
21The prescription may, but is not required to, list the illness,
22disease, or condition for which the drug or device is being
23prescribed. DEA registration numbers shall not be required on
24inpatient drug orders. A prescription for medication other than
25controlled substances shall be valid for up to 15 months from
26the date issued for the purpose of refills, unless the

 

 

HB1442- 15 -LRB101 04917 SMS 49926 b

1prescription states otherwise.
2    (f) "Person" means and includes a natural person,
3partnership, association, corporation, government entity, or
4any other legal entity.
5    (g) "Department" means the Department of Financial and
6Professional Regulation.
7    (h) "Board of Pharmacy" or "Board" means the State Board of
8Pharmacy of the Department of Financial and Professional
9Regulation.
10    (i) "Secretary" means the Secretary of Financial and
11Professional Regulation.
12    (j) "Drug product selection" means the interchange for a
13prescribed pharmaceutical product in accordance with Section
1425 of this Act and Section 3.14 of the Illinois Food, Drug and
15Cosmetic Act.
16    (k) "Inpatient drug order" means an order issued by an
17authorized prescriber for a resident or patient of a facility
18licensed under the Nursing Home Care Act, the ID/DD Community
19Care Act, the MC/DD Act, the Specialized Mental Health
20Rehabilitation Act of 2013, the Hospital Licensing Act, or the
21University of Illinois Hospital Act, or a facility which is
22operated by the Department of Human Services (as successor to
23the Department of Mental Health and Developmental
24Disabilities) or the Department of Corrections.
25    (k-5) "Pharmacist" means an individual health care
26professional and provider currently licensed by this State to

 

 

HB1442- 16 -LRB101 04917 SMS 49926 b

1engage in the practice of pharmacy.
2    (l) "Pharmacist in charge" means the licensed pharmacist
3whose name appears on a pharmacy license and who is responsible
4for all aspects of the operation related to the practice of
5pharmacy.
6    (m) "Dispense" or "dispensing" means the interpretation,
7evaluation, and implementation of a prescription drug order,
8including the preparation and delivery of a drug or device to a
9patient or patient's agent in a suitable container
10appropriately labeled for subsequent administration to or use
11by a patient in accordance with applicable State and federal
12laws and regulations. "Dispense" or "dispensing" does not mean
13the physical delivery to a patient or a patient's
14representative in a home or institution by a designee of a
15pharmacist or by common carrier. "Dispense" or "dispensing"
16also does not mean the physical delivery of a drug or medical
17device to a patient or patient's representative by a
18pharmacist's designee within a pharmacy or drugstore while the
19pharmacist is on duty and the pharmacy is open.
20    (n) "Nonresident pharmacy" means a pharmacy that is located
21in a state, commonwealth, or territory of the United States,
22other than Illinois, that delivers, dispenses, or distributes,
23through the United States Postal Service, commercially
24acceptable parcel delivery service, or other common carrier, to
25Illinois residents, any substance which requires a
26prescription.

 

 

HB1442- 17 -LRB101 04917 SMS 49926 b

1    (o) "Compounding" means the preparation and mixing of
2components, excluding flavorings, (1) as the result of a
3prescriber's prescription drug order or initiative based on the
4prescriber-patient-pharmacist relationship in the course of
5professional practice or (2) for the purpose of, or incident
6to, research, teaching, or chemical analysis and not for sale
7or dispensing. "Compounding" includes the preparation of drugs
8or devices in anticipation of receiving prescription drug
9orders based on routine, regularly observed dispensing
10patterns. Commercially available products may be compounded
11for dispensing to individual patients only if all of the
12following conditions are met: (i) the commercial product is not
13reasonably available from normal distribution channels in a
14timely manner to meet the patient's needs and (ii) the
15prescribing practitioner has requested that the drug be
16compounded.
17    (p) (Blank).
18    (q) (Blank).
19    (r) "Patient counseling" means the communication between a
20pharmacist or a student pharmacist under the supervision of a
21pharmacist and a patient or the patient's representative about
22the patient's medication or device for the purpose of
23optimizing proper use of prescription medications or devices.
24"Patient counseling" may include without limitation (1)
25obtaining a medication history; (2) acquiring a patient's
26allergies and health conditions; (3) facilitation of the

 

 

HB1442- 18 -LRB101 04917 SMS 49926 b

1patient's understanding of the intended use of the medication;
2(4) proper directions for use; (5) significant potential
3adverse events; (6) potential food-drug interactions; and (7)
4the need to be compliant with the medication therapy. A
5pharmacy technician may only participate in the following
6aspects of patient counseling under the supervision of a
7pharmacist: (1) obtaining medication history; (2) providing
8the offer for counseling by a pharmacist or student pharmacist;
9and (3) acquiring a patient's allergies and health conditions.
10    (s) "Patient profiles" or "patient drug therapy record"
11means the obtaining, recording, and maintenance of patient
12prescription information, including prescriptions for
13controlled substances, and personal information.
14    (t) (Blank).
15    (u) "Medical device" or "device" means an instrument,
16apparatus, implement, machine, contrivance, implant, in vitro
17reagent, or other similar or related article, including any
18component part or accessory, required under federal law to bear
19the label "Caution: Federal law requires dispensing by or on
20the order of a physician". A seller of goods and services who,
21only for the purpose of retail sales, compounds, sells, rents,
22or leases medical devices shall not, by reasons thereof, be
23required to be a licensed pharmacy.
24    (v) "Unique identifier" means an electronic signature,
25handwritten signature or initials, thumb print, or other
26acceptable biometric or electronic identification process as

 

 

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1approved by the Department.
2    (w) "Current usual and customary retail price" means the
3price that a pharmacy charges to a non-third-party payor.
4    (x) "Automated pharmacy system" means a mechanical system
5located within the confines of the pharmacy or remote location
6that performs operations or activities, other than compounding
7or administration, relative to storage, packaging, dispensing,
8or distribution of medication, and which collects, controls,
9and maintains all transaction information.
10    (y) "Drug regimen review" means and includes the evaluation
11of prescription drug orders and patient records for (1) known
12allergies; (2) drug or potential therapy contraindications;
13(3) reasonable dose, duration of use, and route of
14administration, taking into consideration factors such as age,
15gender, and contraindications; (4) reasonable directions for
16use; (5) potential or actual adverse drug reactions; (6)
17drug-drug interactions; (7) drug-food interactions; (8)
18drug-disease contraindications; (9) therapeutic duplication;
19(10) patient laboratory values when authorized and available;
20(11) proper utilization (including over or under utilization)
21and optimum therapeutic outcomes; and (12) abuse and misuse.
22    (z) "Electronically transmitted prescription" means a
23prescription that is created, recorded, or stored by electronic
24means; issued and validated with an electronic signature; and
25transmitted by electronic means directly from the prescriber to
26a pharmacy. An electronic prescription is not an image of a

 

 

HB1442- 20 -LRB101 04917 SMS 49926 b

1physical prescription that is transferred by electronic means
2from computer to computer, facsimile to facsimile, or facsimile
3to computer.
4    (aa) "Medication therapy management services" means a
5distinct service or group of services offered by licensed
6pharmacists, physicians licensed to practice medicine in all
7its branches, advanced practice registered nurses authorized
8in a written agreement with a physician licensed to practice
9medicine in all its branches, or physician assistants
10authorized in guidelines by a supervising physician that
11optimize therapeutic outcomes for individual patients through
12improved medication use. In a retail or other non-hospital
13pharmacy, medication therapy management services shall consist
14of the evaluation of prescription drug orders and patient
15medication records to resolve conflicts with the following:
16        (1) known allergies;
17        (2) drug or potential therapy contraindications;
18        (3) reasonable dose, duration of use, and route of
19    administration, taking into consideration factors such as
20    age, gender, and contraindications;
21        (4) reasonable directions for use;
22        (5) potential or actual adverse drug reactions;
23        (6) drug-drug interactions;
24        (7) drug-food interactions;
25        (8) drug-disease contraindications;
26        (9) identification of therapeutic duplication;

 

 

HB1442- 21 -LRB101 04917 SMS 49926 b

1        (10) patient laboratory values when authorized and
2    available;
3        (11) proper utilization (including over or under
4    utilization) and optimum therapeutic outcomes; and
5        (12) drug abuse and misuse.
6    "Medication therapy management services" includes the
7following:
8        (1) documenting the services delivered and
9    communicating the information provided to patients'
10    prescribers within an appropriate time frame, not to exceed
11    48 hours;
12        (2) providing patient counseling designed to enhance a
13    patient's understanding and the appropriate use of his or
14    her medications; and
15        (3) providing information, support services, and
16    resources designed to enhance a patient's adherence with
17    his or her prescribed therapeutic regimens.
18    "Medication therapy management services" may also include
19patient care functions authorized by a physician licensed to
20practice medicine in all its branches for his or her identified
21patient or groups of patients under specified conditions or
22limitations in a standing order from the physician.
23    "Medication therapy management services" in a licensed
24hospital may also include the following:
25        (1) reviewing assessments of the patient's health
26    status; and

 

 

HB1442- 22 -LRB101 04917 SMS 49926 b

1        (2) following protocols of a hospital pharmacy and
2    therapeutics committee with respect to the fulfillment of
3    medication orders.
4    (bb) "Pharmacist care" means the provision by a pharmacist
5of medication therapy management services, with or without the
6dispensing of drugs or devices, intended to achieve outcomes
7that improve patient health, quality of life, and comfort and
8enhance patient safety.
9    (cc) "Protected health information" means individually
10identifiable health information that, except as otherwise
11provided, is:
12        (1) transmitted by electronic media;
13        (2) maintained in any medium set forth in the
14    definition of "electronic media" in the federal Health
15    Insurance Portability and Accountability Act; or
16        (3) transmitted or maintained in any other form or
17    medium.
18    "Protected health information" does not include
19individually identifiable health information found in:
20        (1) education records covered by the federal Family
21    Educational Right and Privacy Act; or
22        (2) employment records held by a licensee in its role
23    as an employer.
24    (dd) "Standing order" means a specific order for a patient
25or group of patients issued by a physician licensed to practice
26medicine in all its branches in Illinois.

 

 

HB1442- 23 -LRB101 04917 SMS 49926 b

1    (ee) "Address of record" means the designated address
2recorded by the Department in the applicant's application file
3or licensee's license file maintained by the Department's
4licensure maintenance unit.
5    (ff) "Home pharmacy" means the location of a pharmacy's
6primary operations.
7    (gg) "Email address of record" means the designated email
8address recorded by the Department in the applicant's
9application file or the licensee's license file, as maintained
10by the Department's licensure maintenance unit.
11(Source: P.A. 99-180, eff. 7-29-15; 100-208, eff. 1-1-18;
12100-497, eff. 9-8-17; 100-513, eff. 1-1-18; 100-804, eff.
131-1-19; 100-863, eff. 8-14-18.)
 
14    Section 40. The Illinois Public Aid Code is amended by
15adding Section 5-5.12c as follows:
 
16    (305 ILCS 5/5-5.12c new)
17    Sec. 5-5.12c. Coverage for patient care services for
18hormonal contraceptives provided by a pharmacist.
19    (a) Subject to approval by the federal Centers for Medicare
20and Medicaid Services, the medical assistance program,
21including both the fee-for-service and managed care medical
22assistance programs established under this Article, shall
23cover patient care services provided by a pharmacist for
24hormonal contraceptives assessment and consultation.

 

 

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1    (b) The Department shall establish a fee schedule for
2patient care services provided by a pharmacist for hormonal
3contraceptives assessment and consultation.
4    (c) The rate of reimbursement for patient care services
5provided by a pharmacist for hormonal contraceptives
6assessment and consultation shall be at 85% of the fee schedule
7for physician services by the medical assistance program.
8    (d) A pharmacist must be enrolled in the medical assistance
9program as an ordering and referring provider prior to
10providing hormonal contraceptives assessment and consultation
11that is submitted by a pharmacy or pharmacist provider for
12reimbursement pursuant to this Section.
13    (e) The Director shall seek any necessary federal waivers
14or approvals to implement this Section. This Section shall not
15be implemented until the receipt of all necessary federal
16waivers or approvals or until January 1, 2022, whichever comes
17first. If federal approval is not obtained by January 1, 2022,
18the provisions of this Section shall be implemented using State
19funds.
20    (f) This Section does not restrict or prohibit any services
21currently provided by pharmacists as authorized by law,
22including, but not limited to, pharmacist services provided
23under this Code or authorized under the Illinois Title XIX
24State Plan.
25    (g) The Department shall adopt administrative rules for
26this Section as soon as practicable but no later than May 1,

 

 

HB1442- 25 -LRB101 04917 SMS 49926 b

12020.
 
2    Section 95. No acceleration or delay. Where this Act makes
3changes in a statute that is represented in this Act by text
4that is not yet or no longer in effect (for example, a Section
5represented by multiple versions), the use of that text does
6not accelerate or delay the taking effect of (i) the changes
7made by this Act or (ii) provisions derived from any other
8Public Act.
 
9    Section 99. Effective date. This Act takes effect January
101, 2020.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 375/6.11
4    20 ILCS 2310/2310-705 new
5    55 ILCS 5/5-1069.3
6    65 ILCS 5/10-4-2.3
7    105 ILCS 5/10-22.3f
8    215 ILCS 5/356z.33 new
9    225 ILCS 85/3
10    305 ILCS 5/5-5.12c new