093_HB0244

 
                                     LRB093 02637 DRJ 02647 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  11-26.1  and  adding  Section  12-4.25d  as
 6    follows:

 7        (305 ILCS 5/11-26.1) (from Ch. 23, par. 11-26.1)
 8        Sec. 11-26.1.  Drug Utilization Review.
 9        (a)  The  Illinois  Department  shall,  within  the  time
10    frames  mandated by federal law, implement a Drug Utilization
11    Review Program (DUR), designed to decrease overutilization of
12    drugs through both prospective and retrospective  utilization
13    review.  The  Illinois Department shall determine the content
14    of the DUR by rule. Prescriptions filled  or  refilled  under
15    subsection  (b)  of  Section  12-4.25d are not subject to the
16    DUR.
17        (b)  The Illinois Department may implement  this  Section
18    as  added  by  this amendatory Act of 1991 through the use of
19    emergency rules in accordance with the provisions of  Section
20    5.02  of  the  Illinois  Administrative  Procedure  Act.  For
21    purposes  of  the  Illinois Administrative Procedure Act, the
22    adoption of rules to implement this Section as added by  this
23    amendatory  Act  of  1991  shall  be  deemed an emergency and
24    necessary for the public interest, safety and welfare.
25    (Source: P.A. 87-14.)

26        (305 ILCS 5/12-4.25d new)
27        Sec.  12-4.25d.  Pharmacy   participation   in   Medicaid
28    program; prescription drug discount benefit.
29        (a)  A  pharmacy  must  comply  with  subsection (b) as a
30    condition of participation in the medical assistance  program
 
                            -2-      LRB093 02637 DRJ 02647 b
 1    under Article V.
 2        (b)  If  a person requests that a pharmacy fill or refill
 3    a  valid  prescription  for  a  prescription  drug  and  also
 4    presents the pharmacy with satisfactory proof that the person
 5    for  whom  the  prescription  is  written   is   a   Medicare
 6    beneficiary  or  a  beneficiary  of pharmaceutical assistance
 7    under the Senior Citizens and Disabled Persons  Property  Tax
 8    Relief  and  Pharmaceutical  Assistance Act, the pharmacy may
 9    not charge a price for filling or refilling the  prescription
10    that exceeds the sum of the following:
11             (1)  The   pharmacy's  reimbursement  rate  for  the
12        prescription drug established by the Department of Public
13        Aid and applicable to prescriptions  filled  or  refilled
14        for recipients of medical assistance under Article V.
15             (2)  An  amount  set  by the of Department of Public
16        Aid to cover the pharmacy's costs relating to the sending
17        or  receipt  of  electronic  transmissions  between   the
18        pharmacy  and  the  Department  concerning  reimbursement
19        rates described under paragraph (1).
20        The  price  restrictions  described in this subsection do
21    not apply to non-prescription or over-the-counter medications
22    or to compounded prescriptions as  defined  in  the  Pharmacy
23    Practice Act of 1987.
24        (c)  The  Department  of  Public  Aid  shall  establish a
25    mechanism to calculate and transmit to pharmacies the maximum
26    prices  that  the  pharmacies  may  charge  for  filling  and
27    refilling  prescriptions   for   prescription   drugs   under
28    subsection (b).
29        (d)  Prescriptions  filled  or  refilled under subsection
30    (b) are not subject to the Department of  Public  Aid's  Drug
31    Utilization Review Program under Section 11-26.1.
32        (e)  The   Department   of   Public   Aid  shall  monitor
33    pharmacies' compliance with this Section and shall  submit  a
34    report  concerning that compliance to the General Assembly by
 
                            -3-      LRB093 02637 DRJ 02647 b
 1    April 1 of each year.  The report shall include, but need not
 2    be  limited  to,  information  concerning   pharmacies   that
 3    discontinue  their  participation  in  the medical assistance
 4    program under Article  V  and  the  reasons  given  by  those
 5    pharmacies for discontinuing their participation.
 6        (f)  The  Department  of Public Aid shall conduct a study
 7    of  its  pharmacy  reimbursement  rates  under   Article   V,
 8    including  the  cost  of  providing  prescription  drugs  and
 9    services.  The  Department  shall  report its findings to the
10    General Assembly by January 1, 2005.
11        (g)  The Department of Public Aid shall provide  consumer
12    information  to all Medicare beneficiaries who reside in this
13    State and to all beneficiaries of  pharmaceutical  assistance
14    under  the  Senior Citizens and Disabled Persons Property Tax
15    Relief and Pharmaceutical Assistance  Act.   The  information
16    must  include a description of the prescription drug discount
17    benefit available  under  subsection  (b),  instructions  for
18    obtaining   the   benefit,   and   prescription   drug  price
19    information  to  ensure  that  prescription   drug   discount
20    beneficiaries are aware of the maximum prices that pharmacies
21    may  charge for prescription drugs under subsection (b).  The
22    Department shall  provide  this  information  by  appropriate
23    means, including the Internet.
24        (h)  The   Department   of   Public   Aid  shall  execute
25    interagency agreements with the Department on Aging  and  the
26    Department  of  Revenue  as necessary to implement subsection
27    (g).  The agreements shall include provisions  for  assisting
28    persons  entitled  to  the prescription drug discount benefit
29    under subsection (b) in obtaining that benefit.
30        (i)  If coverage of prescription drugs is  added  to  the
31    benefits available under the Medicare program, the Department
32    of  Public Aid shall promptly report that fact to the General
33    Assembly.  It is the General  Assembly's  intent  that  under
34    those  circumstances  the General Assembly shall evaluate the
 
                            -4-      LRB093 02637 DRJ 02647 b
 1    continued implementation of this Section.
 2        (j)  This Section is repealed on July 1, 2007.