Full Text of SB2046 97th General Assembly
SB2046 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 SB2046 Introduced 2/10/2011, by Sen. Kirk W. Dillard - Kyle McCarter SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/5-5.12 | from Ch. 23, par. 5-5.12 |
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Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services may by rule provide for reimbursement of the dispensing of a 90-day supply of a generic or brand name (rather than generic), non-narcotic maintenance medication in circumstances where it is cost effective.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| 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).
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| 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. The Department shall review | 10 | | utilization of narcotic medications in the medical assistance | 11 | | program and impose utilization controls that protect against | 12 | | abuse.
| 13 | | (e) When making determinations as to which drugs shall be | 14 | | on a prior approval list, the Department shall include as part | 15 | | of the analysis for this determination, the degree to which a | 16 | | drug may affect individuals in different ways based on factors | 17 | | including the gender of the person taking the medication. | 18 | | (f) The Department shall cooperate with the Department of | 19 | | Public Health and the Department of Human Services Division of | 20 | | Mental Health in identifying psychotropic medications that, | 21 | | when given in a particular form, manner, duration, or frequency | 22 | | (including "as needed") in a dosage, or in conjunction with | 23 | | other psychotropic medications to a nursing home resident, may | 24 | | constitute a chemical restraint or an "unnecessary drug" as | 25 | | defined by the Nursing Home Care Act or Titles XVIII and XIX of | 26 | | the Social Security Act and the implementing rules and |
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| 1 | | regulations. The Department shall require prior approval for | 2 | | any such medication prescribed for a nursing home resident that | 3 | | appears to be a chemical restraint or an unnecessary drug. The | 4 | | Department shall consult with the Department of Human Services | 5 | | Division of Mental Health in developing a protocol and criteria | 6 | | for deciding whether to grant such prior approval. | 7 | | (g) The Department may by rule provide for reimbursement of | 8 | | the dispensing of a 90-day supply of a generic or brand name , | 9 | | non-narcotic maintenance medication in circumstances where it | 10 | | is cost effective. | 11 | | (Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; | 12 | | 96-1501, eff. 1-25-11.)
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