Full Text of HB4096 100th General Assembly
HB4096enr 100TH GENERAL ASSEMBLY |
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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 5-16.11 as follows:
| 6 | | (305 ILCS 5/5-16.11)
| 7 | | Sec. 5-16.11. Uniform standards applied to managed care | 8 | | organizations entities . | 9 | | (a) As used in this Section: | 10 | | "Drug class" means a set of medications that have similar | 11 | | chemical structures, the same mechanism of action (such as | 12 | | binding to the same biological target), a related mode of | 13 | | action, the same method of delivery (such as one pill per day), | 14 | | or that are used to treat the same disease. | 15 | | "Clinician" means an individual licensed by the State of | 16 | | Illinois to prescribe or dispense drugs. | 17 | | (b) Any
Medicaid managed care organization entity | 18 | | providing services under this Code shall use a pharmacy
| 19 | | formulary that is no more restrictive by drug class than the | 20 | | Illinois Department's
preferred drug list. Beginning January | 21 | | 1, 2019 and continuing through January 1, 2022, the Illinois | 22 | | Department shall require each Medicaid managed care | 23 | | organization to list as preferred on the Medicaid managed care |
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| 1 | | organization's preferred drug list at least the same number, | 2 | | and no fewer, of drugs per drug class as are listed on the | 3 | | Illinois Department's preferred drug list. pharmaceutical | 4 | | program.
| 5 | | (c) The Illinois Department shall not prohibit, or adopt | 6 | | any rules or policies that prohibit, a Medicaid managed care | 7 | | organization from: (i) covering additional drugs that are not | 8 | | listed on the Illinois Department's preferred drug list; (ii) | 9 | | submitting all covered drugs listed on the Illinois | 10 | | Department's preferred drug list and additional drugs covered | 11 | | by the Medicaid managed care organization as qualified | 12 | | encounters to be used for appropriate purposes, including, but | 13 | | not limited to, quality scores, risk adjustments, and rate | 14 | | development, as long as the encounter data is submitted with | 15 | | proper formatting criteria; or (iii) removing from the Medicaid | 16 | | managed care organization's preferred drug list any prior | 17 | | approval requirements, step therapy, or other utilization | 18 | | controls applicable under the Illinois Department's preferred | 19 | | drug list. | 20 | | (d) The Illinois Department shall not require a Medicaid | 21 | | managed care organization to utilize a single, statewide | 22 | | preferred drug list and shall not prohibit a plan from | 23 | | negotiating drug pricing concessions or rebates on any drug | 24 | | with pharmaceutical companies, unless otherwise required by | 25 | | federal law. | 26 | | (e) No later than January 1, 2019, the Illinois Department |
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| 1 | | shall develop a standardized format for all Medicaid managed | 2 | | care organization preferred drug lists in collaboration with | 3 | | Medicaid managed care organizations and other stakeholders, | 4 | | including, but not limited to, organizations that serve | 5 | | individuals impacted by HIV/AIDS or epilepsy, and | 6 | | community-based organizations, providers, and entities with | 7 | | expertise in drug formulary development. | 8 | | (f) Following development of the standardized Preferred | 9 | | Drug List format, the Illinois Department shall allow Medicaid | 10 | | managed care organizations 6 months from the date of completion | 11 | | to comply with the new Preferred Drug List format. Each | 12 | | Medicaid managed care organization must post its preferred drug | 13 | | list on its website without restricting access and must update | 14 | | the preferred drug list posted on its website. Medicaid managed | 15 | | care organizations shall publish updates to their preferred | 16 | | drug lists no less than 30 days prior to the date upon which | 17 | | any update or change takes effect, including, but not limited | 18 | | to, any and all changes to requirements for prior approval | 19 | | requirements, step therapy, or other utilization controls. | 20 | | (g)(1) No later than January 1, 2019, the Illinois | 21 | | Department shall establish and maintain the Illinois Pharmacy | 22 | | and Therapeutics Advisory Board. The Board shall have the | 23 | | authority and responsibility to provide recommendations to the | 24 | | Illinois Department regarding which drug products to list on | 25 | | the Illinois Department's preferred drug list. The Illinois | 26 | | Department shall provide administrative support to the Board |
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| 1 | | and the Board shall: | 2 | | (A) convene and meet no less than once per calendar | 3 | | quarter; | 4 | | (B)
provide regular opportunities for public comment; | 5 | | and | 6 | | (C)
comply with the provisions of the Open Meetings | 7 | | Act. | 8 | | All correspondence related to the Board, including | 9 | | correspondence to and from Board members, shall be subject to | 10 | | the Freedom of Information Act. | 11 | | (2) The Board shall consist of the following voting | 12 | | members, all of whom shall be appointed by the Governor and | 13 | | shall serve terms of 3 years without compensation: | 14 | | (A) one pharmacist licensed to practice pharmacy in | 15 | | Illinois who is recommended by a statewide organization | 16 | | representing pharmacists; | 17 | | (B) 4 physicians, recommended by a statewide | 18 | | organization representing physicians, who are licensed to | 19 | | practice medicine in all its branches in Illinois, have | 20 | | knowledge of and adhere to best practice standards, and | 21 | | have experience treating Illinois Medicaid beneficiaries; | 22 | | (C) 2 clinicians representing health care advocacy | 23 | | organizations that serve individuals who are affected by | 24 | | chronic diseases that require significant pharmaceutical | 25 | | treatments; | 26 | | (D) one clinician representing the Illinois |
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| 1 | | Department; and | 2 | | (E) one licensed psychiatrist, recommended by a | 3 | | statewide organization representing psychiatrists, who has | 4 | | experience treating Illinois Medicaid beneficiaries. | 5 | | One non-voting clinician representing each Medicaid health | 6 | | plan operating within the State shall be invited to participate | 7 | | and advise the Board on its recommendations to the Illinois | 8 | | Department. | 9 | | Organizations interested in nominating non-voting | 10 | | clinicians to advise the Board may submit requests to | 11 | | participate to the Illinois Department. | 12 | | (h) The Illinois Department shall adopt rules, to be in | 13 | | place no later than January 1, 2019, for the purpose of | 14 | | establishing and maintaining the Board. | 15 | | (Source: P.A. 92-370, eff. 8-15-01.)
| 16 | | Section 99. Effective date. This Act takes effect upon | 17 | | becoming law.
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