Full Text of SB3213 97th General Assembly
SB3213sam002 97TH GENERAL ASSEMBLY | Sen. David Koehler Filed: 3/22/2012
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| 1 | | AMENDMENT TO SENATE BILL 3213
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 3213 by replacing | 3 | | everything after the enacting clause with the following:
| 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 |
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| 1 | | prescription
drug dispensed. The Illinois Department shall | 2 | | update its
information on the acquisition costs of all | 3 | | prescription drugs
no less frequently than every 30 days. | 4 | | However, the Illinois
Department may set the rate of | 5 | | reimbursement for the acquisition
cost, by rule, at a | 6 | | percentage of the current average wholesale
acquisition cost.
| 7 | | (c) (Blank).
| 8 | | (d) The Department shall not impose requirements for prior | 9 | | approval
based on a preferred drug list for anti-retroviral, | 10 | | anti-hemophilic factor
concentrates,
or
any atypical | 11 | | antipsychotics, conventional antipsychotics,
or | 12 | | anticonvulsants used for the treatment of serious mental
| 13 | | illnesses
until 30 days after it has conducted a study of the | 14 | | impact of such
requirements on patient care and submitted a | 15 | | report to the Speaker of the
House of Representatives and the | 16 | | President of the Senate. The Department shall review | 17 | | utilization of narcotic medications in the medical assistance | 18 | | program and impose utilization controls that protect against | 19 | | abuse.
| 20 | | (e) When making determinations as to which drugs shall be | 21 | | on a prior approval list, the Department shall include as part | 22 | | of the analysis for this determination, the degree to which a | 23 | | drug may affect individuals in different ways based on factors | 24 | | including the gender of the person taking the medication. | 25 | | (f) The Department shall cooperate with the Department of | 26 | | Public Health and the Department of Human Services Division of |
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| 1 | | Mental Health in identifying psychotropic medications that, | 2 | | when given in a particular form, manner, duration, or frequency | 3 | | (including "as needed") in a dosage, or in conjunction with | 4 | | other psychotropic medications to a nursing home resident or to | 5 | | a resident of a facility licensed under the ID/DD MR/DD | 6 | | Community Care Act, may constitute a chemical restraint or an | 7 | | "unnecessary drug" as defined by the Nursing Home Care Act or | 8 | | Titles XVIII and XIX of the Social Security Act and the | 9 | | implementing rules and regulations. The Department shall | 10 | | require prior approval for any such medication prescribed for a | 11 | | nursing home resident or to a resident of a facility licensed | 12 | | under the ID/DD MR/DD Community Care Act, that appears to be a | 13 | | chemical restraint or an unnecessary drug. The Department shall | 14 | | consult with the Department of Human Services Division of | 15 | | Mental Health in developing a protocol and criteria for | 16 | | deciding whether to grant such prior approval. | 17 | | (g) The Department may by rule provide for reimbursement of | 18 | | the dispensing of a 90-day supply of a generic or brand name, | 19 | | non-narcotic maintenance medication in circumstances where it | 20 | | is cost effective. | 21 | | (h) Effective July 1, 2011, the Department shall | 22 | | discontinue coverage of select over-the-counter drugs, | 23 | | including analgesics and cough and cold and allergy | 24 | | medications. | 25 | | (i) The Department shall develop a program of utilization | 26 | | review and control for specialty drugs seek any necessary |
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| 1 | | waiver from the federal government in order to establish a | 2 | | program limiting the pharmacies eligible to dispense specialty | 3 | | drugs and shall issue a Request for Proposals in order to | 4 | | maximize savings on these drugs. The Department shall by rule | 5 | | establish the drugs required to be dispensed in this program. | 6 | | (Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; | 7 | | 96-1501, eff. 1-25-11; 97-38, eff. 6-28-11; 97-74, eff. | 8 | | 6-30-11; 97-333, eff. 8-12-11; 97-426, eff. 1-1-12; revised | 9 | | 10-4-11.)
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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