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.