Bill Text: IL HB5462 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Pharmacy Practice Act. Provides that it is the practice of pharmacy to order and administer vaccines to patients 7 years of age and older for COVID-19 or influenza subcutaneously, intramuscularly, or orally as authorized, approved, or licensed by the United States Food and Drug Administration or in accordance with the United States Centers for Disease Control and Prevention's Recommended Immunization Schedule or the United States Centers for Disease Control and Prevention's Health Information for International Travel (rather than as authorized, approved, or licensed by the United States Food and Drug Administration). Provides that a pharmacist who is exercising his or her professional judgment may change the quantity of medication prescribed if specified conditions are satisfied. Provides that a pharmacist may change the dosage form of a prescription if it is in the best interest of patient care, so long as the prescriber's directions are also modified to equate to an equivalent amount of drug dispensed as prescribed. Provides that a pharmacist may complete missing information on a prescription if there is evidence to support the change. Repeals provisions concerning the administration of vaccines, tests, and therapeutics by registered pharmacy technicians and student pharmacists. Makes other changes. Amends the Illinois Insurance Code and the Medical Assistance Article of the Illinois Public Aid Code. Provides that the ordering and administration of vaccines by a pharmacist as part of the practice of pharmacy shall be covered and reimbursed under the medical assistance program and by other insurers at no less than the rate that the vaccine is reimbursed at when ordered and administered by a licensed physician.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-02-09 - Referred to Rules Committee [HB5462 Detail]

Download: Illinois-2023-HB5462-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5462 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.63
225 ILCS 85/3
225 ILCS 85/20 from Ch. 111, par. 4140
225 ILCS 85/24 from Ch. 111, par. 4144
305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12
225 ILCS 85/9.6 rep.
Amends the Pharmacy Practice Act. Provides that it is the practice of pharmacy to order and administer vaccines to patients 7 years of age and older for COVID-19 or influenza subcutaneously, intramuscularly, or orally as authorized, approved, or licensed by the United States Food and Drug Administration or in accordance with the United States Centers for Disease Control and Prevention's Recommended Immunization Schedule or the United States Centers for Disease Control and Prevention's Health Information for International Travel (rather than as authorized, approved, or licensed by the United States Food and Drug Administration). Provides that a pharmacist who is exercising his or her professional judgment may change the quantity of medication prescribed if specified conditions are satisfied. Provides that a pharmacist may change the dosage form of a prescription if it is in the best interest of patient care, so long as the prescriber's directions are also modified to equate to an equivalent amount of drug dispensed as prescribed. Provides that a pharmacist may complete missing information on a prescription if there is evidence to support the change. Repeals provisions concerning the administration of vaccines, tests, and therapeutics by registered pharmacy technicians and student pharmacists. Makes other changes. Amends the Illinois Insurance Code and the Medical Assistance Article of the Illinois Public Aid Code. Provides that the ordering and administration of vaccines by a pharmacist as part of the practice of pharmacy shall be covered and reimbursed under the medical assistance program and by other insurers at no less than the rate that the vaccine is reimbursed at when ordered and administered by a licensed physician.
LRB103 38877 RTM 69014 b
A BILL FOR
HB5462 LRB103 38877 RTM 69014 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.63 as follows:
(215 ILCS 5/356z.63)
Sec. 356z.63 356z.61. Coverage of pharmacy testing,
screening, vaccinations, and treatment.
(a) A group or individual policy of accident and health
insurance or a managed care plan that is amended, delivered,
issued, or renewed on or after January 1, 2025 shall provide
coverage for health care or patient care services provided by
a pharmacist if:
(1) the pharmacist meets the requirements and scope of
practice described in paragraph (15), (16), or (17) of
subsection (d) of Section 3 of the Pharmacy Practice Act;
(2) the health plan provides coverage for the same
service provided by a licensed physician, an advanced
practice registered nurse, or a physician assistant;
(3) the pharmacist is included in the health benefit
plan's network of participating providers; and
(4) reimbursement has been successfully negotiated in
good faith between the pharmacist and the health plan.

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(b) Vaccines ordered and administered by a pharmacist as
described in subsection (d) of Section 3 of the Pharmacy
Practice Act shall be covered and reimbursed at no less than
the rate that the vaccine is reimbursed at when ordered and
administered by a physician licensed to practice medicine in
all its branches.
(Source: P.A. 103-1, eff. 4-27-23; revised 8-29-23.)
Section 10. The Pharmacy Practice Act is amended by
changing Sections 3, 20, and 24 as follows:
(225 ILCS 85/3)
(Section scheduled to be repealed on January 1, 2028)
Sec. 3. Definitions. For the purpose of this Act, except
where otherwise limited therein:
(a) "Pharmacy" or "drugstore" means and includes every
store, shop, pharmacy department, or other place where
pharmacist care is provided by a pharmacist (1) where drugs,
medicines, or poisons are dispensed, sold or offered for sale
at retail, or displayed for sale at retail; or (2) where
prescriptions of physicians, dentists, advanced practice
registered nurses, physician assistants, veterinarians,
podiatric physicians, or optometrists, within the limits of
their licenses, are compounded, filled, or dispensed; or (3)
which has upon it or displayed within it, or affixed to or used
in connection with it, a sign bearing the word or words

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"Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical Care",
"Apothecary", "Drugstore", "Medicine Store", "Prescriptions",
"Drugs", "Dispensary", "Medicines", or any word or words of
similar or like import, either in the English language or any
other language; or (4) where the characteristic prescription
sign (Rx) or similar design is exhibited; or (5) any store, or
shop, or other place with respect to which any of the above
words, objects, signs or designs are used in any
advertisement.
(b) "Drugs" means and includes (1) articles recognized in
the official United States Pharmacopoeia/National Formulary
(USP/NF), or any supplement thereto and being intended for and
having for their main use the diagnosis, cure, mitigation,
treatment or prevention of disease in man or other animals, as
approved by the United States Food and Drug Administration,
but does not include devices or their components, parts, or
accessories; and (2) all other articles intended for and
having for their main use the diagnosis, cure, mitigation,
treatment or prevention of disease in man or other animals, as
approved by the United States Food and Drug Administration,
but does not include devices or their components, parts, or
accessories; and (3) articles (other than food) having for
their main use and intended to affect the structure or any
function of the body of man or other animals; and (4) articles
having for their main use and intended for use as a component
or any articles specified in clause (1), (2) or (3); but does

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not include devices or their components, parts or accessories.
(c) "Medicines" means and includes all drugs intended for
human or veterinary use approved by the United States Food and
Drug Administration.
(d) "Practice of pharmacy" means:
(1) the interpretation and the provision of assistance
in the monitoring, evaluation, and implementation of
prescription drug orders;
(2) the dispensing of prescription drug orders;
(3) participation in drug and device selection;
(4) drug administration limited to the administration
of oral, topical, injectable, and inhalation as follows:
(A) in the context of patient education on the
proper use or delivery of medications;
(B) vaccination of patients 7 years of age and
older pursuant to a valid prescription or standing
order, by a physician licensed to practice medicine in
all its branches, except for vaccinations covered by
paragraph (15), upon completion of appropriate
training, including how to address contraindications
and adverse reactions set forth by rule, with
notification to the patient's physician and
appropriate record retention, or pursuant to hospital
pharmacy and therapeutics committee policies and
procedures. Eligible vaccines are those listed on the
U.S. Centers for Disease Control and Prevention (CDC)

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Recommended Immunization Schedule, the CDC's Health
Information for International Travel, or the U.S. Food
and Drug Administration's Vaccines Licensed and
Authorized for Use in the United States. As applicable
to the State's Medicaid program and other payers,
vaccines ordered and administered in accordance with
this subsection shall be covered and reimbursed at no
less than the rate that the vaccine is reimbursed when
ordered and administered by a physician;
(B-5) following the initial administration of
long-acting or extended-release form opioid
antagonists by a physician licensed to practice
medicine in all its branches, administration of
injections of long-acting or extended-release form
opioid antagonists for the treatment of substance use
disorder, pursuant to a valid prescription by a
physician licensed to practice medicine in all its
branches, upon completion of appropriate training,
including how to address contraindications and adverse
reactions, including, but not limited to, respiratory
depression and the performance of cardiopulmonary
resuscitation, set forth by rule, with notification to
the patient's physician and appropriate record
retention, or pursuant to hospital pharmacy and
therapeutics committee policies and procedures;
(C) administration of injections of

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alpha-hydroxyprogesterone caproate, pursuant to a
valid prescription, by a physician licensed to
practice medicine in all its branches, upon completion
of appropriate training, including how to address
contraindications and adverse reactions set forth by
rule, with notification to the patient's physician and
appropriate record retention, or pursuant to hospital
pharmacy and therapeutics committee policies and
procedures; and
(D) administration of injections of long-term
antipsychotic medications pursuant to a valid
prescription by a physician licensed to practice
medicine in all its branches, upon completion of
appropriate training conducted by an Accreditation
Council of Pharmaceutical Education accredited
provider, including how to address contraindications
and adverse reactions set forth by rule, with
notification to the patient's physician and
appropriate record retention, or pursuant to hospital
pharmacy and therapeutics committee policies and
procedures.
(5) (blank);
(6) drug regimen review;
(7) drug or drug-related research;
(8) the provision of patient counseling;
(9) the practice of telepharmacy;

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(10) the provision of those acts or services necessary
to provide pharmacist care;
(11) medication therapy management;
(12) the responsibility for compounding and labeling
of drugs and devices (except labeling by a manufacturer,
repackager, or distributor of non-prescription drugs and
commercially packaged legend drugs and devices), proper
and safe storage of drugs and devices, and maintenance of
required records;
(13) the assessment and consultation of patients and
dispensing of hormonal contraceptives;
(14) the initiation, dispensing, or administration of
drugs, laboratory tests, assessments, referrals, and
consultations for human immunodeficiency virus
pre-exposure prophylaxis and human immunodeficiency virus
post-exposure prophylaxis under Section 43.5;
(15) the ordering and administration of vaccines to
vaccination of patients 7 years of age and older for
COVID-19 or influenza subcutaneously, intramuscularly, or
orally as authorized, approved, or licensed by the United
States Food and Drug Administration or in accordance with
the United States Centers for Disease Control and
Prevention's Recommended Immunization Schedule or the
United States Centers for Disease Control and Prevention's
Health Information for International Travel. , pursuant to
the following conditions:

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(A) the vaccine must be authorized or licensed by
the United States Food and Drug Administration;
(B) the vaccine must be ordered and administered
according to the Advisory Committee on Immunization
Practices standard immunization schedule;
(C) the pharmacist must complete a course of
training accredited by the Accreditation Council on
Pharmacy Education or a similar health authority or
professional body approved by the Division of
Professional Regulation;
(D) the pharmacist must have a current certificate
in basic cardiopulmonary resuscitation;
(E) the pharmacist must complete, during each
State licensing period, a minimum of 2 hours of
immunization-related continuing pharmacy education
approved by the Accreditation Council on Pharmacy
Education;
(F) the pharmacist must comply with recordkeeping
and reporting requirements of the jurisdiction in
which the pharmacist administers vaccines, including
informing the patient's primary-care provider, when
available, and complying with requirements whereby the
person administering a vaccine must review the vaccine
registry or other vaccination records prior to
administering the vaccine; and
(G) the pharmacist must inform the pharmacist's

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patients who are less than 18 years old, as well as the
adult caregiver accompanying the child, of the
importance of a well-child visit with a pediatrician
or other licensed primary-care provider and must refer
patients as appropriate;
(16) the ordering and administration of COVID-19
therapeutics subcutaneously, intramuscularly, or orally
with notification to the patient's physician and
appropriate record retention or pursuant to hospital
pharmacy and therapeutics committee policies and
procedures for: (i) COVID-19 (SARS-CoV 2) or other
respiratory illnesses, conditions, or diseases; (ii)
influenza; (iii) group A Streptococcus Pharyngitis; (iv)
lice; (v) skin conditions, including ringworm and
athlete's foot; (vi) respiratory syncytial virus or RSV;
and (vii) other health conditions identified by a
statewide public health emergency, as defined in the
Illinois Emergency Management Agency Act. Eligible
therapeutics are those approved, authorized, or licensed
by the United States Food and Drug Administration and must
be administered subcutaneously, intramuscularly, or orally
in accordance with that approval, authorization, or
licensing; and
(17) the ordering and administration of tests and
screenings for (i) influenza, (ii) SARS-CoV 2 SARS-COV 2,
and (iii) group A Streptococcus Pharyngitis, (iv) lice,

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(v) skin conditions, including ringworm and athlete's
foot, (vi) RSV, and (vii) other health conditions
identified by a statewide public health emergency, as
defined in the Illinois Emergency Management Agency Act,
with notification to the patient's physician and
appropriate record retention or pursuant to hospital
pharmacy and therapeutics committee policies and
procedures. Eligible tests and screenings are those
approved, authorized, or licensed by the United States
Food and Drug Administration and must be administered in
accordance with that approval, authorization, or
licensing.
A pharmacist who orders or administers tests or
screenings for health conditions described in this
paragraph may use a test that may guide clinical
decision-making for the health condition that is waived
under the federal Clinical Laboratory Improvement
Amendments of 1988 and regulations promulgated thereunder
or any established screening procedure that is established
under a statewide protocol.
A pharmacist may delegate the administrative and
technical tasks of performing a test for the health
conditions described in this paragraph to a registered
pharmacy technician or student pharmacist acting under the
supervision of the pharmacist.
A pharmacist who performs any of the acts defined as the

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practice of pharmacy in this State must be actively licensed
as a pharmacist under this Act.
(e) "Prescription" means and includes any written, oral,
facsimile, or electronically transmitted order for drugs or
medical devices, issued by a physician licensed to practice
medicine in all its branches, dentist, veterinarian, podiatric
physician, or optometrist, within the limits of his or her
license, by a physician assistant in accordance with
subsection (f) of Section 4, or by an advanced practice
registered nurse in accordance with subsection (g) of Section
4, containing the following: (1) name of the patient; (2) date
when prescription was issued; (3) name and strength of drug or
description of the medical device prescribed; and (4)
quantity; (5) directions for use; (6) prescriber's name,
address, and signature; and (7) DEA registration number where
required, for controlled substances. The prescription may, but
is not required to, list the illness, disease, or condition
for which the drug or device is being prescribed. DEA
registration numbers shall not be required on inpatient drug
orders. A prescription for medication other than controlled
substances shall be valid for up to 15 months from the date
issued for the purpose of refills, unless the prescription
states otherwise.
(f) "Person" means and includes a natural person,
partnership, association, corporation, government entity, or
any other legal entity.

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(g) "Department" means the Department of Financial and
Professional Regulation.
(h) "Board of Pharmacy" or "Board" means the State Board
of Pharmacy of the Department of Financial and Professional
Regulation.
(i) "Secretary" means the Secretary of Financial and
Professional Regulation.
(j) "Drug product selection" means the interchange for a
prescribed pharmaceutical product in accordance with Section
25 of this Act and Section 3.14 of the Illinois Food, Drug and
Cosmetic Act.
(k) "Inpatient drug order" means an order issued by an
authorized prescriber for a resident or patient of a facility
licensed under the Nursing Home Care Act, the ID/DD Community
Care Act, the MC/DD Act, the Specialized Mental Health
Rehabilitation Act of 2013, the Hospital Licensing Act, or the
University of Illinois Hospital Act, or a facility which is
operated by the Department of Human Services (as successor to
the Department of Mental Health and Developmental
Disabilities) or the Department of Corrections.
(k-5) "Pharmacist" means an individual health care
professional and provider currently licensed by this State to
engage in the practice of pharmacy.
(l) "Pharmacist in charge" means the licensed pharmacist
whose name appears on a pharmacy license and who is
responsible for all aspects of the operation related to the

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practice of pharmacy.
(m) "Dispense" or "dispensing" means the interpretation,
evaluation, and implementation of a prescription drug order,
including the preparation and delivery of a drug or device to a
patient or patient's agent in a suitable container
appropriately labeled for subsequent administration to or use
by a patient in accordance with applicable State and federal
laws and regulations. "Dispense" or "dispensing" does not mean
the physical delivery to a patient or a patient's
representative in a home or institution by a designee of a
pharmacist or by common carrier. "Dispense" or "dispensing"
also does not mean the physical delivery of a drug or medical
device to a patient or patient's representative by a
pharmacist's designee within a pharmacy or drugstore while the
pharmacist is on duty and the pharmacy is open.
(n) "Nonresident pharmacy" means a pharmacy that is
located in a state, commonwealth, or territory of the United
States, other than Illinois, that delivers, dispenses, or
distributes, through the United States Postal Service,
commercially acceptable parcel delivery service, or other
common carrier, to Illinois residents, any substance which
requires a prescription.
(o) "Compounding" means the preparation and mixing of
components, excluding flavorings, (1) as the result of a
prescriber's prescription drug order or initiative based on
the prescriber-patient-pharmacist relationship in the course

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of professional practice or (2) for the purpose of, or
incident to, research, teaching, or chemical analysis and not
for sale or dispensing. "Compounding" includes the preparation
of drugs or devices in anticipation of receiving prescription
drug orders based on routine, regularly observed dispensing
patterns. Commercially available products may be compounded
for dispensing to individual patients only if all of the
following conditions are met: (i) the commercial product is
not reasonably available from normal distribution channels in
a timely manner to meet the patient's needs and (ii) the
prescribing practitioner has requested that the drug be
compounded.
(p) (Blank).
(q) (Blank).
(r) "Patient counseling" means the communication between a
pharmacist or a student pharmacist under the supervision of a
pharmacist and a patient or the patient's representative about
the patient's medication or device for the purpose of
optimizing proper use of prescription medications or devices.
"Patient counseling" may include without limitation (1)
obtaining a medication history; (2) acquiring a patient's
allergies and health conditions; (3) facilitation of the
patient's understanding of the intended use of the medication;
(4) proper directions for use; (5) significant potential
adverse events; (6) potential food-drug interactions; and (7)
the need to be compliant with the medication therapy. A

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pharmacy technician may only participate in the following
aspects of patient counseling under the supervision of a
pharmacist: (1) obtaining medication history; (2) providing
the offer for counseling by a pharmacist or student
pharmacist; and (3) acquiring a patient's allergies and health
conditions.
(s) "Patient profiles" or "patient drug therapy record"
means the obtaining, recording, and maintenance of patient
prescription information, including prescriptions for
controlled substances, and personal information.
(t) (Blank).
(u) "Medical device" or "device" means an instrument,
apparatus, implement, machine, contrivance, implant, in vitro
reagent, or other similar or related article, including any
component part or accessory, required under federal law to
bear the label "Caution: Federal law requires dispensing by or
on the order of a physician". A seller of goods and services
who, only for the purpose of retail sales, compounds, sells,
rents, or leases medical devices shall not, by reasons
thereof, be required to be a licensed pharmacy.
(v) "Unique identifier" means an electronic signature,
handwritten signature or initials, thumb print, or other
acceptable biometric or electronic identification process as
approved by the Department.
(w) "Current usual and customary retail price" means the
price that a pharmacy charges to a non-third-party payor.

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(x) "Automated pharmacy system" means a mechanical system
located within the confines of the pharmacy or remote location
that performs operations or activities, other than compounding
or administration, relative to storage, packaging, dispensing,
or distribution of medication, and which collects, controls,
and maintains all transaction information.
(y) "Drug regimen review" means and includes the
evaluation of prescription drug orders and patient records for
(1) known allergies; (2) drug or potential therapy
contraindications; (3) reasonable dose, duration of use, and
route of administration, taking into consideration factors
such as age, gender, and contraindications; (4) reasonable
directions for use; (5) potential or actual adverse drug
reactions; (6) drug-drug interactions; (7) drug-food
interactions; (8) drug-disease contraindications; (9)
therapeutic duplication; (10) patient laboratory values when
authorized and available; (11) proper utilization (including
over or under utilization) and optimum therapeutic outcomes;
and (12) abuse and misuse.
(z) "Electronically transmitted prescription" means a
prescription that is created, recorded, or stored by
electronic means; issued and validated with an electronic
signature; and transmitted by electronic means directly from
the prescriber to a pharmacy. An electronic prescription is
not an image of a physical prescription that is transferred by
electronic means from computer to computer, facsimile to

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facsimile, or facsimile to computer.
(aa) "Medication therapy management services" means a
distinct service or group of services offered by licensed
pharmacists, physicians licensed to practice medicine in all
its branches, advanced practice registered nurses authorized
in a written agreement with a physician licensed to practice
medicine in all its branches, or physician assistants
authorized in guidelines by a supervising physician that
optimize therapeutic outcomes for individual patients through
improved medication use. In a retail or other non-hospital
pharmacy, medication therapy management services shall consist
of the evaluation of prescription drug orders and patient
medication records to resolve conflicts with the following:
(1) known allergies;
(2) drug or potential therapy contraindications;
(3) reasonable dose, duration of use, and route of
administration, taking into consideration factors such as
age, gender, and contraindications;
(4) reasonable directions for use;
(5) potential or actual adverse drug reactions;
(6) drug-drug interactions;
(7) drug-food interactions;
(8) drug-disease contraindications;
(9) identification of therapeutic duplication;
(10) patient laboratory values when authorized and
available;

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(11) proper utilization (including over or under
utilization) and optimum therapeutic outcomes; and
(12) drug abuse and misuse.
"Medication therapy management services" includes the
following:
(1) documenting the services delivered and
communicating the information provided to patients'
prescribers within an appropriate time frame, not to
exceed 48 hours;
(2) providing patient counseling designed to enhance a
patient's understanding and the appropriate use of his or
her medications; and
(3) providing information, support services, and
resources designed to enhance a patient's adherence with
his or her prescribed therapeutic regimens.
"Medication therapy management services" may also include
patient care functions authorized by a physician licensed to
practice medicine in all its branches for his or her
identified patient or groups of patients under specified
conditions or limitations in a standing order from the
physician.
"Medication therapy management services" in a licensed
hospital may also include the following:
(1) reviewing assessments of the patient's health
status; and
(2) following protocols of a hospital pharmacy and

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therapeutics committee with respect to the fulfillment of
medication orders.
(bb) "Pharmacist care" means the provision by a pharmacist
of medication therapy management services, with or without the
dispensing of drugs or devices, intended to achieve outcomes
that improve patient health, quality of life, and comfort and
enhance patient safety.
(cc) "Protected health information" means individually
identifiable health information that, except as otherwise
provided, is:
(1) transmitted by electronic media;
(2) maintained in any medium set forth in the
definition of "electronic media" in the federal Health
Insurance Portability and Accountability Act; or
(3) transmitted or maintained in any other form or
medium.
"Protected health information" does not include
individually identifiable health information found in:
(1) education records covered by the federal Family
Educational Right and Privacy Act; or
(2) employment records held by a licensee in its role
as an employer.
(dd) "Standing order" means a specific order for a patient
or group of patients issued by a physician licensed to
practice medicine in all its branches in Illinois.
(ee) "Address of record" means the designated address

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recorded by the Department in the applicant's application file
or licensee's license file maintained by the Department's
licensure maintenance unit.
(ff) "Home pharmacy" means the location of a pharmacy's
primary operations.
(gg) "Email address of record" means the designated email
address recorded by the Department in the applicant's
application file or the licensee's license file, as maintained
by the Department's licensure maintenance unit.
(Source: P.A. 102-16, eff. 6-17-21; 102-103, eff. 1-1-22;
102-558, eff. 8-20-21; 102-813, eff. 5-13-22; 102-1051, eff.
1-1-23; 103-1, eff. 4-27-23.)
(225 ILCS 85/20) (from Ch. 111, par. 4140)
(Section scheduled to be repealed on January 1, 2028)
Sec. 20. Dispensing systems.
(a) Two or more pharmacies may establish and use a common
electronic file to maintain required dispensing information.
(b) Pharmacies using such a common electronic file are not
required to physically transfer prescriptions or information
for dispensing purposes between or among pharmacies
participating in the same common prescription file; provided,
however any such common file must contain complete and
adequate records of such prescription and refill dispensed as
stated in Section 18.
(c) The Department may formulate such rules, not

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inconsistent with law, as may be necessary to carry out the
purposes of and to enforce the provisions of this Section
within the following exception: The Department shall not
impose greater requirements on either common electronic files
or a hard copy record system.
(d) Drugs shall in no event be dispensed more frequently
or in larger amounts than the prescriber ordered without
direct prescriber authorization by way of a new prescription
order.
(e) The dispensing by a pharmacist licensed in this State
or another state of a prescription contained in a common
database shall not constitute a transfer, provided that (1)
all pharmacies involved in the transactions pursuant to which
the prescription is dispensed and all pharmacists engaging in
dispensing functions are properly licensed, permitted, or
registered in this State or another jurisdiction, (2) a policy
and procedures manual that governs all participating
pharmacies and pharmacists is available to the Department upon
request and includes the procedure for maintaining appropriate
records for regulatory oversight for tracking a prescription
during each stage of the filling and dispensing process, and
(3) the pharmacists involved in filling and dispensing the
prescription and counseling the patient are identified. A
pharmacist shall be accountable only for the specific tasks
performed.
(f) Nothing in this Section shall prohibit a pharmacist

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who is exercising his or her professional judgment from
dispensing additional quantities of medication up to the total
number of dosage units authorized by the prescriber on the
original prescription and any refills.
(g) A pharmacist who is exercising his or her professional
judgment may change the quantity of medication prescribed if:
(1) the prescribed quantity or package size is not
commercially available;
(2) the change in quantity is related to a change in
dosage form, strength, or therapeutic interchange;
(3) the change extends a maintenance drug for the
limited quantity necessary to coordinate a patient's
refills in a medication synchronization program; and
(4) the change to add missing non-pharmaceutical
devices or durable medical equipment that aid in the
appropriate clinical usage of a medication or achieving a
positive therapeutic outcome.
A pharmacist may change the dosage form of a prescription
if it is in the best interest of patient care, so long as the
prescriber's directions are also modified to equate to an
equivalent amount of drug dispensed as prescribed.
A pharmacist may complete missing information on a
prescription if evidence supports the change.
The change must be documented in the patient's record.
(Source: P.A. 100-497, eff. 9-8-17.)

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(225 ILCS 85/24) (from Ch. 111, par. 4144)
(Section scheduled to be repealed on January 1, 2028)
Sec. 24. It shall be unlawful for any manufacturer or
distributor of a prescription drug, or any person on behalf of
such manufacturer or distributor, to distribute a prescription
drug without charge or for less than its fair market value to
any person directly or indirectly.
Nothing in this Section shall be construed to prohibit the
distribution of a prescription drug:
(a) at a discount in accordance with the laws of the
United States or the State of Illinois;
(b) to a person for use in an investigation conducted
under Federal Food and Drug Administration regulations;
(c) to a patient by a pharmacist in response to a
request written and signed by a medical practitioner which
designates the quantity to be distributed;
(d) to a licensed medical practitioner in response to
a request signed by the practitioner which designates the
quantity to be distributed;
(e) to an agency of the federal government or to a
state government or political subdivision for regulatory
or enforcement purposes;
(f) in an emergency as determined by the laws of the
United States or the State of Illinois; or
(g) to a bona fide charity authorized to possess and
dispense prescription drugs.

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It shall be unlawful to require a pharmacist or pharmacy
to dispense a prescription drug below fair market value,
including the cost of dispensing. Any payor that reimburses a
pharmacy below fair market value, including the cost of
dispensing, shall not be able to include this pharmacy towards
any network adequacy requirements and shall not be in
compliance with any willing provider provisions.
(Source: P.A. 85-796.)
Section 15. The Illinois Public Aid Code is amended by
changing Section 5-5.12 as follows:
(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
Sec. 5-5.12. Pharmacy payments.
(a) Every request submitted by a pharmacy for
reimbursement under this Article for prescription drugs
provided to a recipient of aid under this Article shall
include the name of the prescriber or an acceptable
identification number as established by the Department.
(b) Pharmacies providing prescription drugs under this
Article shall be reimbursed at a rate which shall include a
professional dispensing fee as determined by the Illinois
Department, plus the current acquisition cost of the
prescription drug dispensed. The Illinois Department shall
update its information on the acquisition costs of all
prescription drugs no less frequently than every 30 days.

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However, the Illinois Department may set the rate of
reimbursement for the acquisition cost, by rule, at a
percentage of the current average wholesale acquisition cost.
(c) (Blank).
(d) The Department shall review utilization of narcotic
medications in the medical assistance program and impose
utilization controls that protect against abuse.
(e) When making determinations as to which drugs shall be
on a prior approval list, the Department shall include as part
of the analysis for this determination, the degree to which a
drug may affect individuals in different ways based on factors
including the gender of the person taking the medication.
(f) The Department shall cooperate with the Department of
Public Health and the Department of Human Services Division of
Mental Health in identifying psychotropic medications that,
when given in a particular form, manner, duration, or
frequency (including "as needed") in a dosage, or in
conjunction with other psychotropic medications to a nursing
home resident or to a resident of a facility licensed under the
ID/DD Community Care Act or the MC/DD Act, may constitute a
chemical restraint or an "unnecessary drug" as defined by the
Nursing Home Care Act or Titles XVIII and XIX of the Social
Security Act and the implementing rules and regulations. The
Department shall require prior approval for any such
medication prescribed for a nursing home resident or to a
resident of a facility licensed under the ID/DD Community Care

HB5462 - 26 - LRB103 38877 RTM 69014 b
Act or the MC/DD Act, that appears to be a chemical restraint
or an unnecessary drug. The Department shall consult with the
Department of Human Services Division of Mental Health in
developing a protocol and criteria for deciding whether to
grant such prior approval.
(g) The Department may by rule provide for reimbursement
of the dispensing of a 90-day supply of a generic or brand
name, non-narcotic maintenance medication in circumstances
where it is cost effective.
(g-5) On and after July 1, 2012, the Department may
require the dispensing of drugs to nursing home residents be
in a 7-day supply or other amount less than a 31-day supply.
The Department shall pay only one dispensing fee per 31-day
supply.
(h) Effective July 1, 2011, the Department shall
discontinue coverage of select over-the-counter drugs,
including analgesics and cough and cold and allergy
medications.
(h-5) On and after July 1, 2012, the Department shall
impose utilization controls, including, but not limited to,
prior approval on specialty drugs, oncolytic drugs, drugs for
the treatment of HIV or AIDS, immunosuppressant drugs, and
biological products in order to maximize savings on these
drugs. The Department may adjust payment methodologies for
non-pharmacy billed drugs in order to incentivize the
selection of lower-cost drugs. For drugs for the treatment of

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AIDS, the Department shall take into consideration the
potential for non-adherence by certain populations, and shall
develop protocols with organizations or providers primarily
serving those with HIV/AIDS, as long as such measures intend
to maintain cost neutrality with other utilization management
controls such as prior approval. For hemophilia, the
Department shall develop a program of utilization review and
control which may include, in the discretion of the
Department, prior approvals. The Department may impose special
standards on providers that dispense blood factors which shall
include, in the discretion of the Department, staff training
and education; patient outreach and education; case
management; in-home patient assessments; assay management;
maintenance of stock; emergency dispensing timeframes; data
collection and reporting; dispensing of supplies related to
blood factor infusions; cold chain management and packaging
practices; care coordination; product recalls; and emergency
clinical consultation. The Department may require patients to
receive a comprehensive examination annually at an appropriate
provider in order to be eligible to continue to receive blood
factor.
(i) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.

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(j) On and after July 1, 2012, the Department shall impose
limitations on prescription drugs such that the Department
shall not provide reimbursement for more than 4 prescriptions,
including 3 brand name prescriptions, for distinct drugs in a
30-day period, unless prior approval is received for all
prescriptions in excess of the 4-prescription limit. Drugs in
the following therapeutic classes shall not be subject to
prior approval as a result of the 4-prescription limit:
immunosuppressant drugs, oncolytic drugs, anti-retroviral
drugs, and, on or after July 1, 2014, antipsychotic drugs. On
or after July 1, 2014, the Department may exempt children with
complex medical needs enrolled in a care coordination entity
contracted with the Department to solely coordinate care for
such children, if the Department determines that the entity
has a comprehensive drug reconciliation program.
(k) No medication therapy management program implemented
by the Department shall be contrary to the provisions of the
Pharmacy Practice Act.
(l) Any provider enrolled with the Department that bills
the Department for outpatient drugs and is eligible to enroll
in the federal Drug Pricing Program under Section 340B of the
federal Public Health Service Act shall enroll in that
program. No entity participating in the federal Drug Pricing
Program under Section 340B of the federal Public Health
Service Act may exclude fee-for-service Medicaid from their
participation in that program, however, entities defined in

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Section 1905(l)(2)(B) of the Social Security Act are excluded
from this requirement. This subsection does not apply to
outpatient drugs billed to Medicaid managed care
organizations.
(m) Notwithstanding any other provision of this Code to
the contrary, vaccines ordered and administered by a
pharmacist as described in
subsection (d) of Section 3 of the
Pharmacy Practice Act shall be covered and reimbursed at no
less than the rate that the vaccine is reimbursed at when
ordered and administered by a physician licensed to practice
medicine in all its branches.
(Source: P.A. 102-558, eff. 8-20-21; 102-778, eff. 7-1-22.)