Bill Amendment: IL HB4096 | 2017-2018 | 100th General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: MEDICAID-MCO-PREFERRED RX LIST
Status: 2018-11-28 - Total Veto Stands - No Positive Action Taken [HB4096 Detail]
Download: Illinois-2017-HB4096-House_Amendment_001.html
Bill Title: MEDICAID-MCO-PREFERRED RX LIST
Status: 2018-11-28 - Total Veto Stands - No Positive Action Taken [HB4096 Detail]
Download: Illinois-2017-HB4096-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4096
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2 | AMENDMENT NO. ______. Amend House Bill 4096 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 | changing Section 5-16.11 as follows:
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6 | (305 ILCS 5/5-16.11)
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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. |
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1 | (b) Any
Medicaid managed care organization entity | ||||||
2 | providing services under this Code shall use a pharmacy
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3 | formulary that is no more restrictive by drug class than the | ||||||
4 | Illinois Department's
preferred drug list. Beginning January | ||||||
5 | 1, 2019 and continuing through January 1, 2022, the Illinois | ||||||
6 | Department shall require each Medicaid managed care | ||||||
7 | organization to list as preferred on the Medicaid managed care | ||||||
8 | organization's preferred drug list at least the same number, | ||||||
9 | and no fewer, of drugs per drug class as are listed on the | ||||||
10 | Illinois Department's preferred drug list. pharmaceutical | ||||||
11 | program.
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12 | (c) The Illinois Department shall not prohibit, or adopt | ||||||
13 | any rules or policies that prohibit, a Medicaid managed care | ||||||
14 | organization from: (i) covering additional drugs that are not | ||||||
15 | listed on the Illinois Department's preferred drug list; (ii) | ||||||
16 | submitting all covered drugs listed on the Illinois | ||||||
17 | Department's preferred drug list and additional drugs covered | ||||||
18 | by the Medicaid managed care organization as qualified | ||||||
19 | encounters to be used for appropriate purposes, including, but | ||||||
20 | not limited to, quality scores, risk adjustments, and rate | ||||||
21 | development, as long as the encounter data is submitted with | ||||||
22 | proper formatting criteria; or (iii) removing from the Medicaid | ||||||
23 | managed care organization's preferred drug list any prior | ||||||
24 | approval requirements, step therapy, or other utilization | ||||||
25 | controls applicable under the Illinois Department's preferred | ||||||
26 | drug list. |
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1 | (d) The Illinois Department shall not require a Medicaid | ||||||
2 | managed care organization to utilize a single, statewide | ||||||
3 | preferred drug list and shall not prohibit a plan from | ||||||
4 | negotiating drug pricing concessions or rebates on any drug | ||||||
5 | with pharmaceutical companies, unless otherwise required by | ||||||
6 | federal law. | ||||||
7 | (e) No later than January 1, 2019, the Illinois Department | ||||||
8 | shall develop a standardized format for all Medicaid managed | ||||||
9 | care organization preferred drug lists in collaboration with | ||||||
10 | Medicaid managed care organizations and other stakeholders, | ||||||
11 | including, but not limited to, organizations that serve | ||||||
12 | individuals impacted by HIV/AIDS or epilepsy, and | ||||||
13 | community-based organizations, providers, and entities with | ||||||
14 | expertise in drug formulary development. | ||||||
15 | (f) Following development of the standardized Preferred | ||||||
16 | Drug List format, the Illinois Department shall allow Medicaid | ||||||
17 | managed care organizations 6 months from the date of completion | ||||||
18 | to comply with the new Preferred Drug List format. Each | ||||||
19 | Medicaid managed care organization must post its preferred drug | ||||||
20 | list on its website without restricting access and must update | ||||||
21 | the preferred drug list posted on its website. Medicaid managed | ||||||
22 | care organizations shall publish updates to their preferred | ||||||
23 | drug lists no less than 30 days prior to the date upon which | ||||||
24 | any update or change takes effect, including, but not limited | ||||||
25 | to, any and all changes to requirements for prior approval | ||||||
26 | requirements, step therapy, or other utilization controls. |
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1 | (g)(1) No later than January 1, 2019, the Illinois | ||||||
2 | Department shall establish and maintain the Illinois Pharmacy | ||||||
3 | and Therapeutics Advisory Board. The Board shall have the | ||||||
4 | authority and responsibility to provide recommendations to the | ||||||
5 | Illinois Department regarding which drug products to list on | ||||||
6 | the Illinois Department's preferred drug list. The Illinois | ||||||
7 | Department shall provide administrative support to the Board | ||||||
8 | and the Board shall: | ||||||
9 | (A) convene and meet no less than once per calendar | ||||||
10 | quarter; | ||||||
11 | (B)
provide regular opportunities for public comment; | ||||||
12 | and | ||||||
13 | (C)
comply with the provisions of the Open Meetings | ||||||
14 | Act. | ||||||
15 | All correspondence related to the Board, including | ||||||
16 | correspondence to and from Board members, shall be subject to | ||||||
17 | the Freedom of Information Act. | ||||||
18 | (2) The Board shall consist of the following voting | ||||||
19 | members, all of whom shall be appointed by the Governor and | ||||||
20 | shall serve terms of 3 years without compensation: | ||||||
21 | (A) one pharmacist licensed to practice pharmacy in | ||||||
22 | Illinois who is recommended by a statewide organization | ||||||
23 | representing pharmacists; | ||||||
24 | (B) 4 physicians, recommended by a statewide | ||||||
25 | organization representing physicians, who are licensed to | ||||||
26 | practice medicine in all its branches in Illinois, have |
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1 | knowledge of and adhere to best practice standards, and | ||||||
2 | have experience treating Illinois Medicaid beneficiaries; | ||||||
3 | (C) 2 clinicians representing health care advocacy | ||||||
4 | organizations that serve individuals who are affected by | ||||||
5 | chronic diseases that require significant pharmaceutical | ||||||
6 | treatments; | ||||||
7 | (D) one clinician representing the Illinois | ||||||
8 | Department; and | ||||||
9 | (E) one licensed psychiatrist, recommended by a | ||||||
10 | statewide organization representing psychiatrists, who has | ||||||
11 | experience treating Illinois Medicaid beneficiaries. | ||||||
12 | One non-voting clinician representing each Medicaid health | ||||||
13 | plan operating within the State shall be invited to participate | ||||||
14 | and advise the Board on its recommendations to the Illinois | ||||||
15 | Department. | ||||||
16 | Organizations interested in nominating non-voting | ||||||
17 | clinicians to advise the Board may submit requests to | ||||||
18 | participate to the Illinois Department. | ||||||
19 | (h) The Illinois Department shall adopt rules, to be in | ||||||
20 | place no later than January 1, 2019, for the purpose of | ||||||
21 | establishing and maintaining the Board. | ||||||
22 | (Source: P.A. 92-370, eff. 8-15-01.)
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23 | Section 99. Effective date. This Act takes effect upon | ||||||
24 | becoming law.".
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