093_HB0702sam002











                                     LRB093 05491 DRJ 16212 a

 1                     AMENDMENT TO HOUSE BILL 702

 2        AMENDMENT NO.     .  Amend House Bill  702  by  replacing
 3    the title with the following:

 4        "AN ACT in relation to public aid."; and

 5    by  replacing  everything  after the enacting clause with the
 6    following:

 7        "Section 5. The Illinois Public Aid Code  is  amended  by
 8    changing Section 5-5.12 as follows:

 9        (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
10        Sec. 5-5.12.  Pharmacy payments.
11        (a)  Every   request   submitted   by   a   pharmacy  for
12    reimbursement  under  this  Article  for  prescription  drugs
13    provided to a recipient  of  aid  under  this  Article  shall
14    include   the   name  of  the  prescriber  or  an  acceptable
15    identification number as established by the Department.
16        (b)  Pharmacies providing prescription drugs  under  this
17    Article  shall  be reimbursed at a rate which shall include a
18    professional dispensing fee as  determined  by  the  Illinois
19    Department,   plus   the  current  acquisition  cost  of  the
20    prescription drug dispensed. The  Illinois  Department  shall
 
                            -2-      LRB093 05491 DRJ 16212 a
 1    update  its  information  on  the  acquisition  costs  of all
 2    prescription drugs no less frequently  than  every  30  days.
 3    However,   the  Illinois  Department  may  set  the  rate  of
 4    reimbursement  for  the  acquisition  cost,  by  rule,  at  a
 5    percentage of the current average wholesale acquisition cost.
 6        (c)  Reimbursement under this  Article  for  prescription
 7    drugs  shall  be  limited  to  reimbursement for 4 brand-name
 8    prescription drugs per patient per  month.   This  subsection
 9    applies  only  if  (i) the brand-name drug was not prescribed
10    for an acute or urgent condition, (ii)  the  brand-name  drug
11    was   not  prescribed  for  Alzheimer's  disease,  arthritis,
12    diabetes, HIV/AIDS, a mental health condition, or respiratory
13    disease,  and  (iii)  a  therapeutically  equivalent  generic
14    medication has been approved by the  federal  Food  and  Drug
15    Administration.
16        (d)  The  Department  shall  not  impose requirements for
17    prior  approval  based  on  a   preferred   drug   list   for
18    anti-retroviral  or any atypical antipsychotics, conventional
19    antipsychotics, or anticonvulsants, or  antidepressants  used
20    for  the  treatment of serious mental illnesses until 30 days
21    after it  has  conducted  a  study  of  the  impact  of  such
22    requirements  on  patient  care and submitted a report to the
23    Speaker of the House of Representatives and the President  of
24    the   Senate.    The  Department  shall  adopt  policies  and
25    implement  procedures  that  ensure  continuous   access   to
26    medications  24  hours  per  day,  7  days  per  week.  In an
27    emergency situation, when prior approval or an edit  override
28    is not available, a pharmacy may dispense, and the Department
29    shall pay for, up to a 72-hour supply of a drug prescribed to
30    an  eligible  recipient for a mental illness. Nothing in this
31    Section shall be construed as preventing the Department  from
32    implementing  other  restrictions  as necessary to ensure the
33    appropriate use of medications described in this  subsection,
34    by  persons  with  a  serious mental illness, as supported by
 
                            -3-      LRB093 05491 DRJ 16212 a
 1    evidence-based medicine. This subsection is inoperative after
 2    June 30, 2005.
 3    (Source: P.A. 92-597, eff.  6-28-02;  92-825,  eff.  8-21-02;
 4    revised 9-19-02.)".