Full Text of HB0648 94th General Assembly
HB0648eng 94TH GENERAL ASSEMBLY
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| AN ACT concerning aging.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The State Finance Act is amended by changing | 5 |
| Section 5.595 as follows:
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| (30 ILCS 105/5.595)
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| Sec. 5.595. The Senior Citizens and Disabled Persons
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| Prescription Drug
Discount Program Fund.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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| Section 10. The Senior Citizens and Disabled Persons | 11 |
| Prescription Drug Discount
Program Act is amended by changing | 12 |
| the title of the Act and Sections 1, 10, 15, 20, 25, 30, 35, and | 13 |
| 50 as follows:
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| (320 ILCS 55/Act title)
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| An Act concerning discount prescription drugs for Illinois | 16 |
| residents
senior citizens .
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| (320 ILCS 55/1)
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| Sec. 1. Short title. This Act may be cited as the Senior | 19 |
| Citizens
and
Disabled
Persons Prescription Drug Discount | 20 |
| Program Act.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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| (320 ILCS 55/10)
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| Sec. 10. Purpose. The purpose of this program is to require | 24 |
| the
Department
of
Central Management Services to establish and | 25 |
| administer a program that will
enable
Illinois residents
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| eligible senior citizens and disabled persons to purchase | 27 |
| prescription drugs at
discounted
prices.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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HB0648 Engrossed |
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| (320 ILCS 55/15)
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| Sec. 15. Definitions. As used in this Act:
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| "Authorized pharmacy" means any pharmacy registered in | 4 |
| this State under the
Pharmacy Practice Act of 1987 and approved | 5 |
| by the Department or its program
administrator.
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| "AWP" or "average wholesale price" means the amount | 7 |
| determined from the
latest publication of the Red Book, a | 8 |
| universally subscribed pharmacist
reference guide
annually | 9 |
| published by the Hearst Corporation. "AWP" or "average | 10 |
| wholesale
price"
may also be derived electronically from the | 11 |
| drug pricing database synonymous
with the
latest publication of | 12 |
| the Red Book and furnished in the National Drug Data File
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| (NDDF)
by First Data Bank (FDB), a service of the Hearst | 14 |
| Corporation.
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| "Department" means the Department of Central Management | 16 |
| Services.
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| "Director" means the Director of Central Management | 18 |
| Services.
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| "Disabled person" means a person unable to engage in any | 20 |
| substantial gainful
activity by reason of a medically | 21 |
| determinable physical or mental impairment
which can
be | 22 |
| expected to result in death or has lasted or can be expected to | 23 |
| last for a
continuous
period of not less than 12 months.
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| "Drug manufacturer" means any entity (1) that is located | 25 |
| within or outside
Illinois
that is engaged in (i) the | 26 |
| production, preparation, propagation, compounding,
conversion,
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| or processing of prescription drug products covered under the | 28 |
| program, either
directly or
indirectly by extraction from | 29 |
| substances of natural origin, independently by
means of
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| chemical synthesis, or by a combination of extraction and | 31 |
| chemical synthesis or
(ii) the
packaging, repackaging, | 32 |
| leveling, labeling, or distribution of prescription
drug | 33 |
| products
covered under the program and (2) that elects to | 34 |
| provide prescription drugs
either directly
or under contract | 35 |
| with any entity providing prescription drug services on
behalf |
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| of the
State of Illinois. "Drug manufacturer", however, does | 2 |
| not include a wholesale
distributor
of drugs or a retail | 3 |
| pharmacy licensed under Illinois law.
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| "Eligible senior" means a person who is (i) a resident of | 5 |
| Illinois and (ii)
65 years of
age or older.
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| "Prescription drug" means any prescribed drug that may be | 7 |
| legally dispensed
by
an authorized pharmacy.
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| "Program" means the Senior Citizens and Disabled Persons
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| Prescription Drug
Discount Program created
under this Act.
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| "Program administrator" means the entity that is chosen by | 11 |
| the Department to
administer the program. The program | 12 |
| administrator may, in this case, be the
Director or
a Pharmacy | 13 |
| Benefits Manager (PBM) chosen to subcontract with the Director.
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| "Rules" includes rules adopted and forms prescribed by the | 15 |
| Department.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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| (320 ILCS 55/20)
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| Sec. 20. The Senior Citizens and Disabled Persons
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| Prescription Drug
Discount
Program. The Senior Citizens and | 20 |
| Disabled Persons Prescription Drug Discount
Program
is | 21 |
| established to protect the health and safety of Illinois | 22 |
| residents
senior citizens and disabled
persons . The
program | 23 |
| shall be administered by the Department. The Department or its | 24 |
| program
administrator shall (i) enroll Illinois residents
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| eligible seniors and disabled persons into the
program, as | 26 |
| provided in Section 35 of this Act, to
qualify them for a | 27 |
| discount on the purchase of prescription drugs at an
authorized
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| pharmacy, (ii) enter into rebate agreements with drug | 29 |
| manufacturers, as
provided under Section 30 of this Act, and | 30 |
| (iii) subject to the provisions of
Section 47 of this Act,
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| compensate pharmacies participating in the program
as provided | 32 |
| under Section 25 of this Act.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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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 | 3 |
| program
administrator. If the Department is not the program | 4 |
| administrator, 90 days
after the effective date of this Act, | 5 |
| the Department must
issue a
request for proposals for bidders | 6 |
| interested in administering the program.
Bidders must
compete | 7 |
| on the basis of the following minimum criteria:
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| (1) The Director shall solicit and accept proposals | 9 |
| from entities
to provide for administration of a
program or | 10 |
| programs in accordance with rules adopted under Section 45.
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| Proposals must be submitted not later than a date | 12 |
| established by the Director.
The
Director shall accept only | 13 |
| those proposals that specify the following:
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| (A) The estimated amount of the discount based on | 15 |
| the entity's
previous experience and how the discount | 16 |
| is to be achieved.
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| (B) The extent that discounts on prescription | 18 |
| drugs are to be
achieved through rebates, | 19 |
| administrative fees, or other fees or discounts in
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| prices that the entity negotiates
with drug | 21 |
| manufacturers.
The proposals shall assure that rebates | 22 |
| 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 | 26 |
| program.
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| (C) Any other benefits offered to cardholders.
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| (D) The estimated number and geographic | 29 |
| distribution of
participating pharmacies in the | 30 |
| administrator's
pharmacy network.
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| (E) The plan for pharmacy compensation, pursuant | 32 |
| to subsection (e) of
this Section.
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| (F) The method used for determining the | 34 |
| prescription drugs to be covered
by the program, | 35 |
| including the criteria and process for establishing a | 36 |
| preferred
drug list, if
applicable.
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| (G) How the entity proposes to improve medication | 2 |
| management
for cardholders, including any program of | 3 |
| disease management.
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| (H) How cardholders and participating pharmacies | 5 |
| will be
informed of the discounted price negotiated by | 6 |
| the entity.
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| (I) How the entity will handle complaints about the | 8 |
| program's
operation.
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| (J) The entity's previous experience in managing | 10 |
| similar programs.
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| (K) Any additional information requested by the | 12 |
| Director.
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| (2) The Director shall contract with one or more | 14 |
| entities to administer
a
program or programs on the basis | 15 |
| of the proposals submitted, but may require an
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| administrator to modify its conduct of a program in | 17 |
| accordance with rules
adopted
under Section 45.
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| The Director shall adopt rules specifying the period | 19 |
| for which a contract
will be in effect and may terminate a | 20 |
| contract if an administrator fails to
conduct a
program in | 21 |
| accordance with its proposal or with any modifications | 22 |
| required by
rule. When a contract period ends or a contract | 23 |
| is terminated, the Director
shall
enter into a new contract | 24 |
| in the manner specified in this Section for an
original
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| contract. Prior to making a new contract, the Director may | 26 |
| modify the rules for
administration of the program or | 27 |
| programs.
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| (b) As used in this Section, "administrator" includes the | 29 |
| administrator's
parent
company and any subsidiary of the parent | 30 |
| company.
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| (1) No administrator shall sell any information | 32 |
| concerning a person who
holds a prescription drug discount | 33 |
| card, other than aggregate information that
does not | 34 |
| identify the cardholder, without the cardholder's written | 35 |
| consent.
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| (2) Unless an administrator has the cardholder's |
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| written consent, no
administrator shall use any personally | 2 |
| identifiable information that it obtains
concerning a | 3 |
| cardholder through the program to promote or sell a program | 4 |
| or
product offered by the administrator that is not related | 5 |
| to the administration
of the
program. This subsection (b) | 6 |
| does not prohibit an administrator from
contacting | 7 |
| cardholders concerning participation in or administration | 8 |
| of the
program, including, but not limited to, mailing a | 9 |
| list of pharmacies
participating
in the program's network | 10 |
| or participating in disease management programs.
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| (3) To the extent that a discount is achieved through | 12 |
| rebates,
administrative fees, or any other fees or
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| discounts
in prices that an administrator negotiates with | 14 |
| drug manufacturers, an
administrator shall use the rebates | 15 |
| 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 | 20 |
| from rebates, discounts, administrative fees, or other | 21 |
| fees to
promote its mail order pharmacy operation or the | 22 |
| mail order pharmacy operation
of an affiliate. This | 23 |
| subdivision (b)(4) does not, however, limit the
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| participation of an
Illinois-licensed pharmacy under this | 25 |
| Act if that pharmacy provides
prescription drugs by
mail | 26 |
| order.
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| (c) Beginning on January 1, 2006
2004 , the amount paid by | 28 |
| Illinois residents
eligible
seniors and
disabled persons
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| enrolled in the program to authorized pharmacies for
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| prescription drugs
may not exceed prices established as a | 31 |
| result of the rebate agreements under
Section 30.
The Illinois | 32 |
| residents
eligible
seniors and disabled persons shall pay the | 33 |
| price determined under
Section 30 plus
a dispensing fee of | 34 |
| $3.50 per prescription for brand name drug products,
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| single-source drug products, and, for a period of 6 months, | 36 |
| newly released
generic drug products and
$4.25 per prescription |
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| for all other generic drug products, except that the
total | 2 |
| amount
paid
by the
Illinois resident
eligible
senior or | 3 |
| disabled person for each prescription
drug under
this program | 4 |
| shall not exceed the usual and customary charge for such
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| prescription.
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| (d) The contract between the Department and a pharmacy | 7 |
| benefits manager
must,
at a minimum, meet the criteria of | 8 |
| subsection (a). The contract must also
require
notification by | 9 |
| the pharmacy benefits manager of any proposed or ongoing
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| activity that
involves, directly or indirectly, any conflict of | 11 |
| interest on the part of the
pharmacy
benefits manager. The | 12 |
| Department shall ensure that the pharmacy benefits
manager
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| complies with the contract and shall adopt all procedures | 14 |
| necessary to enforce
the
contract.
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| (e) The Department or program administrator shall,
subject | 16 |
| to the funds available
under
Section 30 of this Act,
compensate | 17 |
| authorized
pharmacies for prescription drugs dispensed under | 18 |
| the program
for the difference between the amount paid by the | 19 |
| Illinois resident
eligible
senior or disabled
person for
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| prescription drugs
dispensed under the program and (i) the AWP | 21 |
| 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 | 23 |
| generic drug products
and (ii) the AWP minus 35% for all
other | 24 |
| generic drug products.
The Department shall compensate a | 25 |
| pharmacy under this subsection (e) only if
the amount paid by | 26 |
| the Illinois resident
eligible
senior or disabled person
has | 27 |
| been discounted to a price, including the dispensing fees | 28 |
| stated in
subsection (c) of this Section, that
is less than (i) | 29 |
| the
AWP
minus 12% for
brand name drug products, single-source | 30 |
| generic
drug products, and, for a period of 6 months, newly | 31 |
| released generic drug
products
and (ii) the AWP minus 35% for | 32 |
| all
other
generic drug products.
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| (f) Beginning on January 1, 2004, the Department or program | 34 |
| administrator
shall
reimburse pharmacies under this Section | 35 |
| within 30 days after adjudication of
the
claim.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| (320 ILCS 55/30)
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| Sec. 30. Manufacturer rebate agreements.
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| (a) Taking into consideration the extent to which the State | 4 |
| pays for
prescription
drugs under various State programs
and | 5 |
| the provision of assistance to disabled persons , senior | 6 |
| citizens, or other Illinois residents
or eligible seniors under
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| patient
assistance programs, prescription drug discount | 8 |
| programs, or other offers for
free or
reduced price medicine, | 9 |
| clinical research projects, limited supply distribution
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| programs,
compassionate use programs, or programs of research | 11 |
| conducted by or for a drug
manufacturer, the Department, its | 12 |
| agent, or the program
administrator shall negotiate and enter | 13 |
| into rebate agreements with drug
manufacturers, as
defined in | 14 |
| this Act, to effect prescription drug price discounts.
The | 15 |
| Department or program administrator may establish a preferred | 16 |
| drug list as
a
basis
for determining the discounts, | 17 |
| administrative fees, or other fees or rebates
under this | 18 |
| Section.
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| (b) Rebate payment procedures. All rebates negotiated | 20 |
| under agreements
described in this Section shall be paid in | 21 |
| accordance with
procedures
prescribed by the Department or the | 22 |
| program administrator.
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| (c) Receipts from rebates
shall be used
to provide | 24 |
| discounts for prescription drugs purchased by Illinois | 25 |
| residents
eligible
seniors and
disabled persons and to cover | 26 |
| the cost of administering the program,
including compensation | 27 |
| to be paid to participating pharmacies by the Department
or | 28 |
| program administrator under subsection (e) of Section 25. Any | 29 |
| receipts to be
allocated to the Department shall be deposited | 30 |
| into the Senior Citizens and
Disabled Persons
Prescription Drug | 31 |
| Discount Program Fund, a special fund hereby created in the
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| State treasury.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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| (320 ILCS 55/35)
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| Sec. 35. Program eligibility.
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| (a) Any resident of Illinois is eligible to participate in | 3 |
| the program and
person may apply to the Department or its | 4 |
| program administrator for
participation in the program in the | 5 |
| form and manner required by the Department.
The
Department or | 6 |
| its program administrator shall determine the eligibility of | 7 |
| each
applicant
for the program within 30 days after the date of | 8 |
| application. To participate in
the program
an Illinois resident
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| eligible
senior or disabled person whose application has been | 10 |
| approved must
pay $25
upon enrollment and annually thereafter | 11 |
| and shall receive a program
identification card.
The card may | 12 |
| be presented to an authorized pharmacy to assist the pharmacy | 13 |
| in
verifying
eligibility under the program. The Department | 14 |
| shall deposit the enrollment fees
collected
into the Senior | 15 |
| Citizens and Disabled Persons Prescription Drug Discount
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| Program Fund.
The moneys collected by the Department for | 17 |
| enrollment fees and deposited into
the Prescription Drug | 18 |
| Discount Program Fund or, before January 1, 2006, into the
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| Senior
Citizens and Disabled Persons Prescription Drug | 20 |
| Discount Program Fund , must be
separately accounted for by the | 21 |
| Department. If 2 or more persons are eligible
for any
benefit | 22 |
| under this Act and are members of the same household, each
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| participating
household member shall apply to the Department | 24 |
| and pay the fee required for the
purpose
of obtaining an | 25 |
| identification card.
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| (b) Proceeds from annual enrollment fees shall be
used
by | 27 |
| the Department to offset the administrative cost of this Act. | 28 |
| The Department
may
reduce the annual enrollment fee by rule if | 29 |
| the revenue from the enrollment
fees is in
excess of the costs | 30 |
| to carry out the program.
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| (c) Any person who is eligible for pharmaceutical | 32 |
| assistance under the
Senior
Citizens and Disabled Persons | 33 |
| Property Tax Relief and Pharmaceutical Assistance
Act is
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| presumed to be eligible for this program. The enrollment fee | 35 |
| under this Act is
not required for such persons. That person | 36 |
| may purchase prescription
drugs
under this program that are not |
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| covered by the pharmaceutical assistance
program under
the | 2 |
| Senior Citizens and Disabled Persons Property Tax Relief and | 3 |
| Pharmaceutical
Assistance Act by using the identification card | 4 |
| issued under the pharmaceutical
assistance
program.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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| (320 ILCS 55/50)
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| Sec. 50. Report on administration of program. The | 8 |
| Department shall
report
to
the Governor and the General | 9 |
| Assembly by March 1st of each year on the
administration
of the | 10 |
| program under this Act.
The report shall include but not be | 11 |
| limited to the following:
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| (1) for periods before January 1, 2006, the number of | 13 |
| disabled persons and seniors eligible and enrolled in
the
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| program, by county; and, for periods after December 31, | 15 |
| 2005, the number of Illinois residents enrolled in the | 16 |
| program;
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| (2) the activities undertaken by the State to inform | 18 |
| disabled persons
and
seniors (for periods before January 1, | 19 |
| 2006) and all Illinois residents (for periods after | 20 |
| December 31, 2005) about the program;
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| (3) the number of prescriptions filled under the | 22 |
| program for enrollees,
and
the estimated savings for | 23 |
| enrollees;
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| (4) a listing of the manufacturers and pharmacies | 25 |
| participating in the
program;
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| (5) the amount of enrollment fees and rebates collected | 27 |
| under the
program, and any additional funds or resources | 28 |
| made available to cover the cost
of the program;
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| (6) the itemized annual cost of administering the | 30 |
| program; and
| 31 |
| (7) findings and recommendations regarding problems | 32 |
| and solutions
related to the program, together with | 33 |
| proposals for changes in the rules,
regulations,
or laws | 34 |
| necessary to improve the administration of the program.
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| (Source: P.A. 93-18, eff. 7-1-03.)
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HB0648 Engrossed |
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LRB094 04076 DRJ 34096 b |
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| (320 ILCS 55/17 rep.)
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| Section 15. The Senior Citizens and Disabled Persons | 3 |
| Prescription Drug Discount
Program Act is amended by repealing | 4 |
| Section 17.
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