Bill Text: IL SB3213 | 2011-2012 | 97th General Assembly | Amended

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 by rule establish the drugs, excluding clotting factor, required to be dispensed in the Department's pharmacy specialty drugs program (rather than the Department shall by rule establish the drugs required to be dispensed in the Department's pharmacy specialty drugs program).

Sponsorship: Partisan Bill (Democrat 1)

Status: (Failed) 2013-01-08 - Session Sine Die [SB3213 Detail]

Download: Illinois-2011-SB3213-Amended.html

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Sen. David Koehler

Filed: 3/22/2012

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AMENDMENT TO SENATE BILL 3213
AMENDMENT NO. ______. Amend Senate Bill 3213 by replacing
everything after the enacting clause with the following:
"Section 5. 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

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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.
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 not impose requirements for prior
approval based on a preferred drug list for anti-retroviral,
anti-hemophilic factor concentrates, or any atypical
antipsychotics, conventional antipsychotics, or
anticonvulsants used for the treatment of serious mental
illnesses until 30 days after it has conducted a study of the
impact of such requirements on patient care and submitted a
report to the Speaker of the House of Representatives and the
President of the Senate. 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

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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 MR/DD
Community Care 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 MR/DD Community Care 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.
(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.
(i) The Department shall develop a program of utilization
review and control for specialty drugs seek any necessary

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waiver from the federal government in order to establish a
program limiting the pharmacies eligible to dispense specialty
drugs and shall issue a Request for Proposals in order to
maximize savings on these drugs. The Department shall by rule
establish the drugs required to be dispensed in this program.
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
96-1501, eff. 1-25-11; 97-38, eff. 6-28-11; 97-74, eff.
6-30-11; 97-333, eff. 8-12-11; 97-426, eff. 1-1-12; revised
10-4-11.)
Section 99. Effective date. This Act takes effect upon
becoming law.".