Illinois General Assembly - Full Text of HB0135
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Full Text of HB0135  102nd General Assembly

HB0135enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
HB0135 EnrolledLRB102 02749 BMS 12752 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    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

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1by the Department of Central Management 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

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1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

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1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12adding Section 356z.43 as follows:
 
13    (215 ILCS 5/356z.43 new)
14    Sec. 356z.43. Coverage for patient care services provided
15by a pharmacist. A group or individual policy of accident and
16health insurance or a managed care plan that is amended,
17delivered, issued, or renewed on or after January 1, 2023
18shall provide coverage for health care or patient care
19services provided by a pharmacist if:
20        (1) the pharmacist meets the requirements and scope of
21    practice as set forth in Section 43 of the Pharmacy
22    Practice Act;
23        (2) the health plan provides coverage for the same
24    service provided by a licensed physician, an advanced

 

 

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1    practice registered nurse, or a physician assistant;
2        (3) the pharmacist is included in the health benefit
3    plan's network of participating providers; and
4        (4) a reimbursement has been successfully negotiated
5    in good faith between the pharmacist and the health plan.
 
6    Section 30. The Pharmacy Practice Act is amended by
7changing Section 3 and by adding Section 43 as follows:
 
8    (225 ILCS 85/3)
9    (Section scheduled to be repealed on January 1, 2023)
10    Sec. 3. Definitions. For the purpose of this Act, except
11where otherwise limited therein:
12    (a) "Pharmacy" or "drugstore" means and includes every
13store, shop, pharmacy department, or other place where
14pharmacist care is provided by a pharmacist (1) where drugs,
15medicines, or poisons are dispensed, sold or offered for sale
16at retail, or displayed for sale at retail; or (2) where
17prescriptions of physicians, dentists, advanced practice
18registered nurses, physician assistants, veterinarians,
19podiatric physicians, or optometrists, within the limits of
20their licenses, are compounded, filled, or dispensed; or (3)
21which has upon it or displayed within it, or affixed to or used
22in connection with it, a sign bearing the word or words
23"Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical Care",
24"Apothecary", "Drugstore", "Medicine Store", "Prescriptions",

 

 

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1"Drugs", "Dispensary", "Medicines", or any word or words of
2similar or like import, either in the English language or any
3other language; or (4) where the characteristic prescription
4sign (Rx) or similar design is exhibited; or (5) any store, or
5shop, or other place with respect to which any of the above
6words, objects, signs or designs are used in any
7advertisement.
8    (b) "Drugs" means and includes (1) articles recognized in
9the official United States Pharmacopoeia/National Formulary
10(USP/NF), or any supplement thereto and being intended for and
11having for their main use the diagnosis, cure, mitigation,
12treatment or prevention of disease in man or other animals, as
13approved by the United States Food and Drug Administration,
14but does not include devices or their components, parts, or
15accessories; and (2) all other articles intended for and
16having for their main use the diagnosis, cure, mitigation,
17treatment or prevention of disease in man or other animals, as
18approved by the United States Food and Drug Administration,
19but does not include devices or their components, parts, or
20accessories; and (3) articles (other than food) having for
21their main use and intended to affect the structure or any
22function of the body of man or other animals; and (4) articles
23having for their main use and intended for use as a component
24or any articles specified in clause (1), (2) or (3); but does
25not include devices or their components, parts or accessories.
26    (c) "Medicines" means and includes all drugs intended for

 

 

HB0135 Enrolled- 9 -LRB102 02749 BMS 12752 b

1human or veterinary use approved by the United States Food and
2Drug Administration.
3    (d) "Practice of pharmacy" means:
4        (1) the interpretation and the provision of assistance
5    in the monitoring, evaluation, and implementation of
6    prescription drug orders;
7        (2) the dispensing of prescription drug orders;
8        (3) participation in drug and device selection;
9        (4) drug administration limited to the administration
10    of oral, topical, injectable, and inhalation as follows:
11            (A) in the context of patient education on the
12        proper use or delivery of medications;
13            (B) vaccination of patients 14 years of age and
14        older pursuant to a valid prescription or standing
15        order, by a physician licensed to practice medicine in
16        all its branches, upon completion of appropriate
17        training, including how to address contraindications
18        and adverse reactions set forth by rule, with
19        notification to the patient's physician and
20        appropriate record retention, or pursuant to hospital
21        pharmacy and therapeutics committee policies and
22        procedures;
23            (B-5) following the initial administration of
24        long-acting or extended-release extended release form
25        opioid antagonists by a physician licensed to practice
26        medicine in all its branches, administration of

 

 

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1        injections of long-acting or extended-release form
2        opioid antagonists for the treatment of substance use
3        disorder, pursuant to a valid prescription by a
4        physician licensed to practice medicine in all its
5        branches, upon completion of appropriate training,
6        including how to address contraindications and adverse
7        reactions, including, but not limited to, respiratory
8        depression and the performance of cardiopulmonary
9        resuscitation, set forth by rule, with notification to
10        the patient's physician and appropriate record
11        retention, or pursuant to hospital pharmacy and
12        therapeutics committee policies and procedures;
13            (C) administration of injections of
14        alpha-hydroxyprogesterone caproate, pursuant to a
15        valid prescription, by a physician licensed to
16        practice medicine in all its branches, upon completion
17        of appropriate training, including how to address
18        contraindications and adverse reactions set forth by
19        rule, with notification to the patient's physician and
20        appropriate record retention, or pursuant to hospital
21        pharmacy and therapeutics committee policies and
22        procedures; and
23            (D) administration of injections of long-term
24        antipsychotic medications pursuant to a valid
25        prescription by a physician licensed to practice
26        medicine in all its branches, upon completion of

 

 

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1        appropriate training conducted by an Accreditation
2        Council of Pharmaceutical Education accredited
3        provider, including how to address contraindications
4        and adverse reactions set forth by rule, with
5        notification to the patient's physician and
6        appropriate record retention, or pursuant to hospital
7        pharmacy and therapeutics committee policies and
8        procedures.
9        (5) vaccination of patients ages 10 through 13 limited
10    to the Influenza (inactivated influenza vaccine and live
11    attenuated influenza intranasal vaccine) and Tdap (defined
12    as tetanus, diphtheria, acellular pertussis) vaccines,
13    pursuant to a valid prescription or standing order, by a
14    physician licensed to practice medicine in all its
15    branches, upon completion of appropriate training,
16    including how to address contraindications and adverse
17    reactions set forth by rule, with notification to the
18    patient's physician and appropriate record retention, or
19    pursuant to hospital pharmacy and therapeutics committee
20    policies and procedures;
21        (6) drug regimen review;
22        (7) drug or drug-related research;
23        (8) the provision of patient counseling;
24        (9) the practice of telepharmacy;
25        (10) the provision of those acts or services necessary
26    to provide pharmacist care;

 

 

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1        (11) medication therapy management; and
2        (12) the responsibility for compounding and labeling
3    of drugs and devices (except labeling by a manufacturer,
4    repackager, or distributor of non-prescription drugs and
5    commercially packaged legend drugs and devices), proper
6    and safe storage of drugs and devices, and maintenance of
7    required records; and .
8        (13) the assessment and consultation of patients and
9    dispensing of hormonal contraceptives.
10    A pharmacist who performs any of the acts defined as the
11practice of pharmacy in this State must be actively licensed
12as a pharmacist under this Act.
13    (e) "Prescription" means and includes any written, oral,
14facsimile, or electronically transmitted order for drugs or
15medical devices, issued by a physician licensed to practice
16medicine in all its branches, dentist, veterinarian, podiatric
17physician, or optometrist, within the limits of his or her
18license, by a physician assistant in accordance with
19subsection (f) of Section 4, or by an advanced practice
20registered nurse in accordance with subsection (g) of Section
214, containing the following: (1) name of the patient; (2) date
22when prescription was issued; (3) name and strength of drug or
23description of the medical device prescribed; and (4)
24quantity; (5) directions for use; (6) prescriber's name,
25address, and signature; and (7) DEA registration number where
26required, for controlled substances. The prescription may, but

 

 

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1is not required to, list the illness, disease, or condition
2for which the drug or device is being prescribed. DEA
3registration numbers shall not be required on inpatient drug
4orders. A prescription for medication other than controlled
5substances shall be valid for up to 15 months from the date
6issued for the purpose of refills, unless the prescription
7states otherwise.
8    (f) "Person" means and includes a natural person,
9partnership, association, corporation, government entity, or
10any other legal entity.
11    (g) "Department" means the Department of Financial and
12Professional Regulation.
13    (h) "Board of Pharmacy" or "Board" means the State Board
14of Pharmacy of the Department of Financial and Professional
15Regulation.
16    (i) "Secretary" means the Secretary of Financial and
17Professional Regulation.
18    (j) "Drug product selection" means the interchange for a
19prescribed pharmaceutical product in accordance with Section
2025 of this Act and Section 3.14 of the Illinois Food, Drug and
21Cosmetic Act.
22    (k) "Inpatient drug order" means an order issued by an
23authorized prescriber for a resident or patient of a facility
24licensed under the Nursing Home Care Act, the ID/DD Community
25Care Act, the MC/DD Act, the Specialized Mental Health
26Rehabilitation Act of 2013, the Hospital Licensing Act, or the

 

 

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1University of Illinois Hospital Act, or a facility which is
2operated by the Department of Human Services (as successor to
3the Department of Mental Health and Developmental
4Disabilities) or the Department of Corrections.
5    (k-5) "Pharmacist" means an individual health care
6professional and provider currently licensed by this State to
7engage in the practice of pharmacy.
8    (l) "Pharmacist in charge" means the licensed pharmacist
9whose name appears on a pharmacy license and who is
10responsible for all aspects of the operation related to the
11practice of pharmacy.
12    (m) "Dispense" or "dispensing" means the interpretation,
13evaluation, and implementation of a prescription drug order,
14including the preparation and delivery of a drug or device to a
15patient or patient's agent in a suitable container
16appropriately labeled for subsequent administration to or use
17by a patient in accordance with applicable State and federal
18laws and regulations. "Dispense" or "dispensing" does not mean
19the physical delivery to a patient or a patient's
20representative in a home or institution by a designee of a
21pharmacist or by common carrier. "Dispense" or "dispensing"
22also does not mean the physical delivery of a drug or medical
23device to a patient or patient's representative by a
24pharmacist's designee within a pharmacy or drugstore while the
25pharmacist is on duty and the pharmacy is open.
26    (n) "Nonresident pharmacy" means a pharmacy that is

 

 

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1located in a state, commonwealth, or territory of the United
2States, other than Illinois, that delivers, dispenses, or
3distributes, through the United States Postal Service,
4commercially acceptable parcel delivery service, or other
5common carrier, to Illinois residents, any substance which
6requires a prescription.
7    (o) "Compounding" means the preparation and mixing of
8components, excluding flavorings, (1) as the result of a
9prescriber's prescription drug order or initiative based on
10the prescriber-patient-pharmacist relationship in the course
11of professional practice or (2) for the purpose of, or
12incident to, research, teaching, or chemical analysis and not
13for sale or dispensing. "Compounding" includes the preparation
14of drugs or devices in anticipation of receiving prescription
15drug orders based on routine, regularly observed dispensing
16patterns. Commercially available products may be compounded
17for dispensing to individual patients only if all of the
18following conditions are met: (i) the commercial product is
19not reasonably available from normal distribution channels in
20a timely manner to meet the patient's needs and (ii) the
21prescribing practitioner has requested that the drug be
22compounded.
23    (p) (Blank).
24    (q) (Blank).
25    (r) "Patient counseling" means the communication between a
26pharmacist or a student pharmacist under the supervision of a

 

 

HB0135 Enrolled- 16 -LRB102 02749 BMS 12752 b

1pharmacist and a patient or the patient's representative about
2the patient's medication or device for the purpose of
3optimizing proper use of prescription medications or devices.
4"Patient counseling" may include without limitation (1)
5obtaining a medication history; (2) acquiring a patient's
6allergies and health conditions; (3) facilitation of the
7patient's understanding of the intended use of the medication;
8(4) proper directions for use; (5) significant potential
9adverse events; (6) potential food-drug interactions; and (7)
10the need to be compliant with the medication therapy. A
11pharmacy technician may only participate in the following
12aspects of patient counseling under the supervision of a
13pharmacist: (1) obtaining medication history; (2) providing
14the offer for counseling by a pharmacist or student
15pharmacist; and (3) acquiring a patient's allergies and health
16conditions.
17    (s) "Patient profiles" or "patient drug therapy record"
18means the obtaining, recording, and maintenance of patient
19prescription information, including prescriptions for
20controlled substances, and personal information.
21    (t) (Blank).
22    (u) "Medical device" or "device" means an instrument,
23apparatus, implement, machine, contrivance, implant, in vitro
24reagent, or other similar or related article, including any
25component part or accessory, required under federal law to
26bear the label "Caution: Federal law requires dispensing by or

 

 

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1on the order of a physician". A seller of goods and services
2who, only for the purpose of retail sales, compounds, sells,
3rents, or leases medical devices shall not, by reasons
4thereof, be required to be a licensed pharmacy.
5    (v) "Unique identifier" means an electronic signature,
6handwritten signature or initials, thumb print, or other
7acceptable biometric or electronic identification process as
8approved by the Department.
9    (w) "Current usual and customary retail price" means the
10price that a pharmacy charges to a non-third-party payor.
11    (x) "Automated pharmacy system" means a mechanical system
12located within the confines of the pharmacy or remote location
13that performs operations or activities, other than compounding
14or administration, relative to storage, packaging, dispensing,
15or distribution of medication, and which collects, controls,
16and maintains all transaction information.
17    (y) "Drug regimen review" means and includes the
18evaluation of prescription drug orders and patient records for
19(1) known allergies; (2) drug or potential therapy
20contraindications; (3) reasonable dose, duration of use, and
21route of administration, taking into consideration factors
22such as age, gender, and contraindications; (4) reasonable
23directions for use; (5) potential or actual adverse drug
24reactions; (6) drug-drug interactions; (7) drug-food
25interactions; (8) drug-disease contraindications; (9)
26therapeutic duplication; (10) patient laboratory values when

 

 

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1authorized and available; (11) proper utilization (including
2over or under utilization) and optimum therapeutic outcomes;
3and (12) abuse and misuse.
4    (z) "Electronically transmitted prescription" means a
5prescription that is created, recorded, or stored by
6electronic means; issued and validated with an electronic
7signature; and transmitted by electronic means directly from
8the prescriber to a pharmacy. An electronic prescription is
9not an image of a physical prescription that is transferred by
10electronic means from computer to computer, facsimile to
11facsimile, or facsimile to computer.
12    (aa) "Medication therapy management services" means a
13distinct service or group of services offered by licensed
14pharmacists, physicians licensed to practice medicine in all
15its branches, advanced practice registered nurses authorized
16in a written agreement with a physician licensed to practice
17medicine in all its branches, or physician assistants
18authorized in guidelines by a supervising physician that
19optimize therapeutic outcomes for individual patients through
20improved medication use. In a retail or other non-hospital
21pharmacy, medication therapy management services shall consist
22of the evaluation of prescription drug orders and patient
23medication records to resolve conflicts with the following:
24        (1) known allergies;
25        (2) drug or potential therapy contraindications;
26        (3) reasonable dose, duration of use, and route of

 

 

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1    administration, taking into consideration factors such as
2    age, gender, and contraindications;
3        (4) reasonable directions for use;
4        (5) potential or actual adverse drug reactions;
5        (6) drug-drug interactions;
6        (7) drug-food interactions;
7        (8) drug-disease contraindications;
8        (9) identification of therapeutic duplication;
9        (10) patient laboratory values when authorized and
10    available;
11        (11) proper utilization (including over or under
12    utilization) and optimum therapeutic outcomes; and
13        (12) drug abuse and misuse.
14    "Medication therapy management services" includes the
15following:
16        (1) documenting the services delivered and
17    communicating the information provided to patients'
18    prescribers within an appropriate time frame, not to
19    exceed 48 hours;
20        (2) providing patient counseling designed to enhance a
21    patient's understanding and the appropriate use of his or
22    her medications; and
23        (3) providing information, support services, and
24    resources designed to enhance a patient's adherence with
25    his or her prescribed therapeutic regimens.
26    "Medication therapy management services" may also include

 

 

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1patient care functions authorized by a physician licensed to
2practice medicine in all its branches for his or her
3identified patient or groups of patients under specified
4conditions or limitations in a standing order from the
5physician.
6    "Medication therapy management services" in a licensed
7hospital may also include the following:
8        (1) reviewing assessments of the patient's health
9    status; and
10        (2) following protocols of a hospital pharmacy and
11    therapeutics committee with respect to the fulfillment of
12    medication orders.
13    (bb) "Pharmacist care" means the provision by a pharmacist
14of medication therapy management services, with or without the
15dispensing of drugs or devices, intended to achieve outcomes
16that improve patient health, quality of life, and comfort and
17enhance patient safety.
18    (cc) "Protected health information" means individually
19identifiable health information that, except as otherwise
20provided, is:
21        (1) transmitted by electronic media;
22        (2) maintained in any medium set forth in the
23    definition of "electronic media" in the federal Health
24    Insurance Portability and Accountability Act; or
25        (3) transmitted or maintained in any other form or
26    medium.

 

 

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1    "Protected health information" does not include
2individually identifiable health information found in:
3        (1) education records covered by the federal Family
4    Educational Right and Privacy Act; or
5        (2) employment records held by a licensee in its role
6    as an employer.
7    (dd) "Standing order" means a specific order for a patient
8or group of patients issued by a physician licensed to
9practice medicine in all its branches in Illinois.
10    (ee) "Address of record" means the designated address
11recorded by the Department in the applicant's application file
12or licensee's license file maintained by the Department's
13licensure maintenance unit.
14    (ff) "Home pharmacy" means the location of a pharmacy's
15primary operations.
16    (gg) "Email address of record" means the designated email
17address recorded by the Department in the applicant's
18application file or the licensee's license file, as maintained
19by the Department's licensure maintenance unit.
20(Source: P.A. 100-208, eff. 1-1-18; 100-497, eff. 9-8-17;
21100-513, eff. 1-1-18; 100-804, eff. 1-1-19; 100-863, eff.
228-14-18; 101-349, eff. 1-1-20; revised 8-21-20.)
 
23    (225 ILCS 85/43 new)
24    Sec. 43. Dispensation of hormonal contraceptives.
25    (a) The dispensing of hormonal contraceptives to a patient

 

 

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1shall be pursuant to a valid prescription or standing order by
2a physician licensed to practice medicine in all its branches
3or the medical director of a local health department, pursuant
4to the following:
5        (1) a pharmacist may dispense no more than a 12-month
6    supply of hormonal contraceptives to a patient;
7        (2) a pharmacist must complete an educational training
8    program accredited by the Accreditation Council for
9    Pharmacy Education and approved by the Department that is
10    related to the patient self-screening risk assessment,
11    patient assessment contraceptive counseling and education,
12    and dispensation of hormonal contraceptives;
13        (3) a pharmacist shall have the patient complete the
14    self-screening risk assessment tool; the self-screening
15    risk assessment tool is to be based on the most current
16    version of the United States Medical Eligibility Criteria
17    for Contraceptive Use published by the federal Centers for
18    Disease Control and Prevention;
19        (4) based upon the results of the self-screening risk
20    assessment and the patient assessment, the pharmacist
21    shall use his or her professional and clinical judgment as
22    to when a patient should be referred to the patient's
23    physician or another health care provider;
24        (5) a pharmacist shall provide, during the patient
25    assessment and consultation, counseling and education
26    about all methods of contraception, including methods not

 

 

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1    covered under the standing order, and their proper use and
2    effectiveness;
3        (6) the patient consultation shall take place in a
4    private manner; and
5        (7) a pharmacist and pharmacy must maintain
6    appropriate records.
7    (b) The Department may adopt rules to implement this
8Section.
9    (c) Nothing in this Section shall be interpreted to
10require a pharmacist to dispense hormonal contraception under
11a standing order issued by a physician licensed to practice
12medicine in all its branches or the medical director of a local
13health department.
 
14    Section 35. The Illinois Public Aid Code is amended by
15adding Section 5-5.12d as follows:
 
16    (305 ILCS 5/5-5.12d new)
17    Sec. 5-5.12d. Coverage for patient care services for
18hormonal contraceptives provided by a pharmacist.
19    (a) Subject to approval by the federal Centers for
20Medicare and Medicaid Services, the medical assistance
21program, including both the fee-for-service and managed care
22medical assistance programs established under this Article,
23shall cover 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
7schedule for physician services by the medical assistance
8program.
9    (d) A pharmacist must be enrolled in the medical
10assistance program as an ordering and referring provider prior
11to providing hormonal contraceptives assessment and
12consultation that is submitted by a pharmacy or pharmacist
13provider for reimbursement pursuant to this Section.
14    (e) The Department shall apply for any necessary federal
15waivers or approvals to implement this Section by January 1,
162022.
17    (f) This Section does not restrict or prohibit any
18services currently provided by pharmacists as authorized by
19law, including, but not limited to, pharmacist services
20provided under this Code or authorized under the Illinois
21Title XIX State Plan.
22    (g) The Department shall submit to the Joint Committee on
23Administrative Rules administrative rules for this Section as
24soon as practicable but no later than 6 months after federal
25approval is received.
 
26    Section 99. Effective date. This Act takes effect on

 

 

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1January 1, 2022, except that Section 25 takes effect on
2January 1, 2023.