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
 
                            -2-      LRB093 11643 DRJ 15103 b
 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.