Full Text of SB3155 93rd General Assembly
SB3155sam001 93RD GENERAL ASSEMBLY
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Sen. Debbie DeFrancesco Halvorson
Filed: 2/25/2004
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LRB093 19814 AMC 47896 a |
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| AMENDMENT TO SENATE BILL 3155
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| AMENDMENT NO. ______. Amend Senate Bill 3155 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The Senior Citizens and Disabled Persons | 5 |
| Prescription Drug Discount
Program Act is amended by changing | 6 |
| Section 25 as follows:
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| (320 ILCS 55/25)
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| Sec. 25. Program administration.
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| (a) The Department is authorized under this Act to be the | 10 |
| program
administrator. If the Department is not the program | 11 |
| administrator, 90 days
after the effective date of this Act, | 12 |
| the Department must
issue a
request for proposals for bidders | 13 |
| interested in administering the program.
Bidders must
compete | 14 |
| on the basis of the following minimum criteria:
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| (1) The Director shall solicit and accept proposals | 16 |
| from entities
to provide for administration of a
program or | 17 |
| programs in accordance with rules adopted under Section 45.
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| Proposals must be submitted not later than a date | 19 |
| established by the Director.
The
Director shall accept only | 20 |
| those proposals that specify the following:
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| (A) The estimated amount of the discount based on | 22 |
| the entity's
previous experience and how the discount | 23 |
| is to be achieved.
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| (B) The extent that discounts on prescription |
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| drugs are to be
achieved through rebates, | 2 |
| administrative fees, or other fees or discounts in
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| prices that the entity negotiates
with drug | 4 |
| manufacturers.
The proposals shall assure that rebates | 5 |
| or discounts
will be
used to do the following:
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| (i) reduce
costs to cardholders;
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| (ii) achieve discounts for cardholders; and
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| (iii) cover costs for administering the | 9 |
| program.
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| (C) Any other benefits offered to cardholders.
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| (D) The estimated number and geographic | 12 |
| distribution of
participating pharmacies in the | 13 |
| administrator's
pharmacy network.
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| (E) The plan for pharmacy compensation, pursuant | 15 |
| to subsection (e) of
this Section.
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| (F) The method used for determining the | 17 |
| prescription drugs to be covered
by the program, | 18 |
| including the criteria and process for establishing a | 19 |
| preferred
drug list, if
applicable.
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| (G) How the entity proposes to improve medication | 21 |
| management
for cardholders, including any program of | 22 |
| disease management.
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| (H) How cardholders and participating pharmacies | 24 |
| will be
informed of the discounted price negotiated by | 25 |
| the entity.
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| (I) How the entity will handle complaints about the | 27 |
| program's
operation.
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| (J) The entity's previous experience in managing | 29 |
| similar programs.
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| (K) Any additional information requested by the | 31 |
| Director.
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| (2) The Director shall contract with one or more | 33 |
| entities to administer
a
program or programs on the basis | 34 |
| of the proposals submitted, but may require an
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| administrator to modify its conduct of a program in | 2 |
| accordance with rules
adopted
under Section 45.
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| The Director shall adopt rules specifying the period | 4 |
| for which a contract
will be in effect and may terminate a | 5 |
| contract if an administrator fails to
conduct a
program in | 6 |
| accordance with its proposal or with any modifications | 7 |
| required by
rule. When a contract period ends or a contract | 8 |
| is terminated, the Director
shall
enter into a new contract | 9 |
| in the manner specified in this Section for an
original
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| contract. Prior to making a new contract, the Director may | 11 |
| modify the rules for
administration of the program or | 12 |
| programs.
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| (b) As used in this Section, "administrator" includes the | 14 |
| administrator's
parent
company and any subsidiary of the parent | 15 |
| company.
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| (1) No administrator shall sell any information | 17 |
| concerning a person who
holds a prescription drug discount | 18 |
| card, other than aggregate information that
does not | 19 |
| identify the cardholder, without the cardholder's written | 20 |
| consent.
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| (2) Unless an administrator has the cardholder's | 22 |
| written consent, no
administrator shall use any personally | 23 |
| identifiable information that it obtains
concerning a | 24 |
| cardholder through the program to promote or sell a program | 25 |
| or
product offered by the administrator that is not related | 26 |
| to the administration
of the
program. This subsection (b) | 27 |
| does not prohibit an administrator from
contacting | 28 |
| cardholders concerning participation in or administration | 29 |
| of the
program, including, but not limited to, mailing a | 30 |
| list of pharmacies
participating
in the program's network | 31 |
| or participating in disease management programs.
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| (3) To the extent that a discount is achieved through | 33 |
| rebates,
administrative fees, or any other fees or
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| discounts
in prices that an administrator negotiates with |
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| drug manufacturers, an
administrator shall use the rebates | 2 |
| or discounts to do the following:
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| (A) reduce costs to cardholders;
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| (B) achieve discounts for cardholders; and
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| (C) cover any administrative costs of the program.
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| (4) The administrator shall not use any funds
generated | 7 |
| from rebates, discounts, administrative fees, or other | 8 |
| fees to
promote its mail order pharmacy operation or the | 9 |
| mail order pharmacy operation
of an affiliate. This | 10 |
| subdivision (b)(4) does not, however, limit the
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| participation of an
Illinois-licensed pharmacy under this | 12 |
| Act if that pharmacy provides
prescription drugs by
mail | 13 |
| order.
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| (c) Beginning on January 1, 2004 and until the effective | 15 |
| date of this amendatory Act of the 93rd General Assembly , the | 16 |
| amount paid by eligible seniors and
disabled persons enrolled | 17 |
| in the program to authorized pharmacies for
prescription drugs
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| may not exceed prices established as a result of the rebate | 19 |
| agreements under
Section 30.
The eligible seniors and disabled | 20 |
| persons shall pay the price determined under
Section 30 plus
a | 21 |
| dispensing fee of $3.50 per prescription for brand name drug | 22 |
| products,
single-source drug products, and, for a period of 6 | 23 |
| months, newly released
generic drug products and
$4.25 per | 24 |
| prescription for all other generic drug products, except that | 25 |
| the
total amount
paid
by the
eligible senior or disabled person | 26 |
| for each prescription
drug under
this program shall not exceed | 27 |
| the usual and customary charge for such
prescription.
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| (c-5) Beginning on the effective date of this amendatory | 29 |
| Act of the 93rd General Assembly, the amount paid by eligible | 30 |
| seniors and
disabled persons enrolled in the program to | 31 |
| authorized pharmacies for
prescription drugs
may not exceed | 32 |
| amounts agreed upon between the Department or the program | 33 |
| administrator and the participating pharmacy. The eligible | 34 |
| seniors and disabled persons shall pay the lesser of the amount |
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| agreed upon or the usual and customary charge for such | 2 |
| prescription.
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| (d) The contract between the Department and a pharmacy | 4 |
| benefits manager
must,
at a minimum, meet the criteria of | 5 |
| subsection (a). The contract must also
require
notification by | 6 |
| the pharmacy benefits manager of any proposed or ongoing
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| activity that
involves, directly or indirectly, any conflict of | 8 |
| interest on the part of the
pharmacy
benefits manager. The | 9 |
| Department shall ensure that the pharmacy benefits
manager
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| complies with the contract and shall adopt all procedures | 11 |
| necessary to enforce
the
contract.
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| (e) (Blank).
The Department or program administrator | 13 |
| shall,
subject to the funds available
under
Section 30 of this | 14 |
| Act,
compensate authorized
pharmacies for prescription drugs | 15 |
| dispensed under the program
for the difference between the | 16 |
| amount paid by the eligible senior or disabled
person for
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| prescription drugs
dispensed under the program and (i) the AWP | 18 |
| minus 12% for
brand name drug products, single-source generic
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| drug products, and, for a period of 6 months,
newly released | 20 |
| generic drug products
and (ii) the AWP minus 35% for all
other | 21 |
| generic drug products.
The Department shall compensate a | 22 |
| pharmacy under this subsection (e) only if
the amount paid by | 23 |
| the eligible senior or disabled person
has been discounted to a | 24 |
| price, including the dispensing fees stated in
subsection (c) | 25 |
| of this Section, that
is less than (i) the
AWP
minus 12% for
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| brand name drug products, single-source generic
drug products, | 27 |
| and, for a period of 6 months, newly released generic drug
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| products
and (ii) the AWP minus 35% for all
other
generic drug | 29 |
| products.
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| (f) Beginning on January 1, 2004, the Department or program | 31 |
| administrator
shall
reimburse pharmacies under this Section | 32 |
| within 30 days after adjudication of
the
claim for claims made | 33 |
| based on prescription drugs dispensed under the program before | 34 |
| the effective date of this amendatory Act of the 93rd General |
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| Assembly. .
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| (Source: P.A. 93-18, eff. 7-1-03.)
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| Section 99. Effective date. This Act takes effect upon | 4 |
| becoming law.".
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