Illinois General Assembly - Full Text of SB1415
Illinois General Assembly

Previous General Assemblies

Full Text of SB1415  95th General Assembly



SB1415 Engrossed LRB095 11023 DRJ 31338 b

1     AN ACT concerning 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 reimbursement
9 under this Article for prescription drugs provided to a
10 recipient of aid under this Article shall include the name of
11 the prescriber or an acceptable identification number as
12 established by the Department.
13     (b) Pharmacies providing prescription drugs under this
14 Article shall be reimbursed at a rate which shall include a
15 professional dispensing fee as determined by the Illinois
16 Department, plus the current acquisition cost of the
17 prescription drug dispensed. The Illinois Department shall
18 update its information on the acquisition costs of all
19 prescription drugs no less frequently than every 30 days.
20 However, the Illinois Department may set the rate of
21 reimbursement for the acquisition cost, by rule, at a
22 percentage of the current average wholesale acquisition cost.
23     (c) (Blank).



SB1415 Engrossed - 2 - LRB095 11023 DRJ 31338 b

1     (d) The Department shall not impose requirements for prior
2 approval based on a preferred drug list for anti-retroviral,
3 anti-hemophilic factor concentrates, or any atypical
4 antipsychotics, conventional antipsychotics, or
5 anticonvulsants used for the treatment of serious mental
6 illnesses until 30 days after it has conducted a study of the
7 impact of such requirements on patient care and submitted a
8 report to the Speaker of the House of Representatives and the
9 President of the Senate.
10     (e) The General Assembly finds as follows:
11         (1) Organ transplant patients require significant
12     physician oversight and interaction.
13         (2) The Centers for Medicare and Medicaid Services has
14     indicated that immunosuppressive products be protected
15     from prior authorization, step therapy, product
16     substitution, quantity limits, or other managed care
17     practices as one of 6 protected classes of products under
18     the Medicare Part D program.
19         (3) This same protection should be afforded to
20     immunosuppressive products under the State Medicaid
21     program. Differences in products could result in adverse
22     effects, including death, and physicians should be the
23     decision-makers when choices regarding immunosuppressive
24     products are concerned.
25     Based on these findings, an immunosuppressive drug shall
26 not require prior authorization, step therapy, generic



SB1415 Engrossed - 3 - LRB095 11023 DRJ 31338 b

1 substitution, or quantity limits without express written or
2 oral notification and the documented consent of the
3 practitioner and the patient. For purposes of this subsection,
4 "immunosuppressive drug" means a drug that is issued in
5 immunosuppressive therapy to inhibit or prevent activity of the
6 immune system and is used to prevent the rejection of
7 transplanted organs and tissues. Immunosuppressive drugs do
8 not include drugs for the treatment of autoimmune diseases or
9 diseases that are most likely of autoimmune origin.
10 (Source: P.A. 93-106, eff. 7-8-03; 94-48, eff. 7-1-05.)
11     Section 99. Effective date. This Act takes effect upon
12 becoming law.