Bill Amendment: IL HB3479 | 2017-2018 | 100th General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: MEDICAID-MCCN-PHARMACY RATES
Status: 2019-01-08 - Session Sine Die [HB3479 Detail]
Download: Illinois-2017-HB3479-Senate_Amendment_003.html
Bill Title: MEDICAID-MCCN-PHARMACY RATES
Status: 2019-01-08 - Session Sine Die [HB3479 Detail]
Download: Illinois-2017-HB3479-Senate_Amendment_003.html
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1 | AMENDMENT TO HOUSE BILL 3479
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2 | AMENDMENT NO. ______. Amend House Bill 3479 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | adding Section 5-30.8 as follows:
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6 | (305 ILCS 5/5-30.8 new) | ||||||
7 | Sec. 5-30.8. Pharmacy reimbursement rates; managed care. | ||||||
8 | (a) As used in this Section: | ||||||
9 | "Actual acquisition cost" means the listed amount for a | ||||||
10 | pharmaceutical product on the pharmacy provider's billing | ||||||
11 | invoice. | ||||||
12 | "Pharmacy benefits manager" means an entity that | ||||||
13 | administers or manages a pharmacy benefits plan or program. | ||||||
14 | (b) The Department shall require a managed care | ||||||
15 | organization, including any pharmacy benefits manager, to | ||||||
16 | reimburse pharmacy providers equal to the Department's |
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1 | fee-for-service reimbursement rates. | ||||||
2 | (c) The reimbursement rate for prescription medications | ||||||
3 | shall include a professional dispensing fee, which shall equal | ||||||
4 | the fee-for-service professional dispensing fee utilized by | ||||||
5 | the Department. | ||||||
6 | (d) The Department shall require a managed care | ||||||
7 | organization, including any pharmacy benefits manager, to | ||||||
8 | reimburse pharmacies for patient care services provided by a | ||||||
9 | pharmacist at no less than 85% of the fee schedule for | ||||||
10 | physician services. | ||||||
11 | (e) Any pharmacy provider may appeal the reimbursement rate | ||||||
12 | for prescription medications or patient care services. | ||||||
13 | (1) The Department shall have the authority to require | ||||||
14 | the managed care organization or pharmacy benefits manager | ||||||
15 | to submit information to the Department related to the | ||||||
16 | managed care organization's or pharmacy benefits manager's | ||||||
17 | pricing methodology and rationale. | ||||||
18 | (2) The managed care organization or pharmacy benefits | ||||||
19 | manager must respond to the request for information no | ||||||
20 | later than 7 days after the date upon which the request is | ||||||
21 | made. If the managed care organization or pharmacy benefits | ||||||
22 | manager does not respond to the Department's request within | ||||||
23 | 7 days after the date upon which the request is made, the | ||||||
24 | Department shall render a final decision in favor of the | ||||||
25 | pharmacy provider. | ||||||
26 | (f) At no time shall a pharmacy provider that contracts |
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1 | with a managed care organization or pharmacy benefits manager | ||||||
2 | be forced to dispense any prescription medication for a | ||||||
3 | reimbursement rate below the actual acquisition cost. | ||||||
4 | (g) The contracting of pharmacy providers shall be | ||||||
5 | separated from any other group or national pharmacy provider | ||||||
6 | contract offered by a pharmacy benefits manager. | ||||||
7 | (h) Medicaid pharmacy provider participation must remain | ||||||
8 | voluntary, as under the fee-for-service medical assistance | ||||||
9 | program. | ||||||
10 | (i) A pharmacy benefits manager shall not require a | ||||||
11 | pharmacy provider to participate in a Medicaid managed care | ||||||
12 | organization's provider network. | ||||||
13 | (j) A pharmacy provider may decline to participate in a | ||||||
14 | contract with a pharmacy benefits manager and remain a | ||||||
15 | fee-for-service provider. | ||||||
16 | (k) No later than January 1, 2019, the Auditor General | ||||||
17 | shall initiate an audit of Medicaid managed care organizations | ||||||
18 | contracted with the Department and pharmacy benefits managers | ||||||
19 | contracted with Medicaid managed care organizations to | ||||||
20 | determine if their reimbursement methodologies are fair and to | ||||||
21 | determine the amount of Medicaid dollars retained by the | ||||||
22 | pharmacy benefits managers.
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23 | Section 99. Effective date. This Act takes effect upon | ||||||
24 | becoming law.".
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