Bill Text: IL HB4096 | 2017-2018 | 100th General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall require each Medicaid Managed Care Organization to list as preferred on the Medicaid Managed Care Organization's preferred drug list every pharmaceutical that is listed as preferred on the Department's preferred drug list. Provides that the Department shall not prohibit, or adopt any rules or policies that prohibit, a Medicaid Managed Care Organization from: (i) covering additional pharmaceuticals that are not listed on the Department's preferred drug list; or (ii) removing from the Medicaid Managed Care Organization's preferred drug list any prior approval requirements applicable under the Department's preferred drug list. Provides that the Department shall not require a Medicaid Managed Care Organization to utilize a single, statewide preferred drug list and shall not prohibit a plan from negotiating drug pricing concessions or rebates on any drug with pharmaceutical companies, unless otherwise required by federal law. Provides that no later than July 1, 2018, the Department shall develop a standardized format for all Medicaid Managed Care Organization preferred drug lists in cooperation with Medicaid Managed Care Organizations and stakeholders, including, but not limited to, community-based organizations, providers, and individuals or entities with expertise in drug formulary development. Requires each Medicaid Managed Care Organization to post its preferred drug list on its website without restricting access to enrolled members and to update the preferred drug list posted on its website within 2 business days of making any changes to the preferred drug list, including, but not limited to, any and all changes to requirements for prior approval. Effective immediately.

Spectrum: Partisan Bill (Democrat 31-0)

Status: (Failed) 2018-11-28 - Total Veto Stands - No Positive Action Taken [HB4096 Detail]

Download: Illinois-2017-HB4096-Enrolled.html

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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-16.11 as follows:
(305 ILCS 5/5-16.11)
Sec. 5-16.11. Uniform standards applied to managed care
organizations entities.
(a) As used in this Section:
"Drug class" means a set of medications that have similar
chemical structures, the same mechanism of action (such as
binding to the same biological target), a related mode of
action, the same method of delivery (such as one pill per day),
or that are used to treat the same disease.
"Clinician" means an individual licensed by the State of
Illinois to prescribe or dispense drugs.
(b) Any Medicaid managed care organization entity
providing services under this Code shall use a pharmacy
formulary that is no more restrictive by drug class than the
Illinois Department's preferred drug list. Beginning January
1, 2019 and continuing through January 1, 2022, the Illinois
Department shall require each Medicaid managed care
organization to list as preferred on the Medicaid managed care

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organization's preferred drug list at least the same number,
and no fewer, of drugs per drug class as are listed on the
Illinois Department's preferred drug list. pharmaceutical
program.
(c) The Illinois Department shall not prohibit, or adopt
any rules or policies that prohibit, a Medicaid managed care
organization from: (i) covering additional drugs that are not
listed on the Illinois Department's preferred drug list; (ii)
submitting all covered drugs listed on the Illinois
Department's preferred drug list and additional drugs covered
by the Medicaid managed care organization as qualified
encounters to be used for appropriate purposes, including, but
not limited to, quality scores, risk adjustments, and rate
development, as long as the encounter data is submitted with
proper formatting criteria; or (iii) removing from the Medicaid
managed care organization's preferred drug list any prior
approval requirements, step therapy, or other utilization
controls applicable under the Illinois Department's preferred
drug list.
(d) The Illinois Department shall not require a Medicaid
managed care organization to utilize a single, statewide
preferred drug list and shall not prohibit a plan from
negotiating drug pricing concessions or rebates on any drug
with pharmaceutical companies, unless otherwise required by
federal law.
(e) No later than January 1, 2019, the Illinois Department

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shall develop a standardized format for all Medicaid managed
care organization preferred drug lists in collaboration with
Medicaid managed care organizations and other stakeholders,
including, but not limited to, organizations that serve
individuals impacted by HIV/AIDS or epilepsy, and
community-based organizations, providers, and entities with
expertise in drug formulary development.
(f) Following development of the standardized Preferred
Drug List format, the Illinois Department shall allow Medicaid
managed care organizations 6 months from the date of completion
to comply with the new Preferred Drug List format. Each
Medicaid managed care organization must post its preferred drug
list on its website without restricting access and must update
the preferred drug list posted on its website. Medicaid managed
care organizations shall publish updates to their preferred
drug lists no less than 30 days prior to the date upon which
any update or change takes effect, including, but not limited
to, any and all changes to requirements for prior approval
requirements, step therapy, or other utilization controls.
(g)(1) No later than January 1, 2019, the Illinois
Department shall establish and maintain the Illinois Pharmacy
and Therapeutics Advisory Board. The Board shall have the
authority and responsibility to provide recommendations to the
Illinois Department regarding which drug products to list on
the Illinois Department's preferred drug list. The Illinois
Department shall provide administrative support to the Board

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and the Board shall:
(A) convene and meet no less than once per calendar
quarter;
(B) provide regular opportunities for public comment;
and
(C) comply with the provisions of the Open Meetings
Act.
All correspondence related to the Board, including
correspondence to and from Board members, shall be subject to
the Freedom of Information Act.
(2) The Board shall consist of the following voting
members, all of whom shall be appointed by the Governor and
shall serve terms of 3 years without compensation:
(A) one pharmacist licensed to practice pharmacy in
Illinois who is recommended by a statewide organization
representing pharmacists;
(B) 4 physicians, recommended by a statewide
organization representing physicians, who are licensed to
practice medicine in all its branches in Illinois, have
knowledge of and adhere to best practice standards, and
have experience treating Illinois Medicaid beneficiaries;
(C) 2 clinicians representing health care advocacy
organizations that serve individuals who are affected by
chronic diseases that require significant pharmaceutical
treatments;
(D) one clinician representing the Illinois

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Department; and
(E) one licensed psychiatrist, recommended by a
statewide organization representing psychiatrists, who has
experience treating Illinois Medicaid beneficiaries.
One non-voting clinician representing each Medicaid health
plan operating within the State shall be invited to participate
and advise the Board on its recommendations to the Illinois
Department.
Organizations interested in nominating non-voting
clinicians to advise the Board may submit requests to
participate to the Illinois Department.
(h) The Illinois Department shall adopt rules, to be in
place no later than January 1, 2019, for the purpose of
establishing and maintaining the Board.
(Source: P.A. 92-370, eff. 8-15-01.)
Section 99. Effective date. This Act takes effect upon
becoming law.