Illinois 2023-2024 Regular Session

Illinois House Bill HB5462 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5462 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.63225 ILCS 85/3225 ILCS 85/20 from Ch. 111, par. 4140225 ILCS 85/24 from Ch. 111, par. 4144305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12225 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 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5462 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.63225 ILCS 85/3225 ILCS 85/20 from Ch. 111, par. 4140225 ILCS 85/24 from Ch. 111, par. 4144305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12225 ILCS 85/9.6 rep. 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 LRB103 38877 RTM 69014 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5462 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356z.63225 ILCS 85/3225 ILCS 85/20 from Ch. 111, par. 4140225 ILCS 85/24 from Ch. 111, par. 4144305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12225 ILCS 85/9.6 rep. 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.
4	4	215 ILCS 5/356z.63
5	5	225 ILCS 85/3
6	6	225 ILCS 85/20 from Ch. 111, par. 4140
7	7	225 ILCS 85/24 from Ch. 111, par. 4144
8	8	305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12
9	9	225 ILCS 85/9.6 rep.
10	10	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.
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13	13	A BILL FOR
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16	16	1 AN ACT concerning regulation.
17	17	2 Be it enacted by the People of the State of Illinois,
18	18	3 represented in the General Assembly:
19	19	4 Section 5. The Illinois Insurance Code is amended by
20	20	5 changing Section 356z.63 as follows:
21	21	6 (215 ILCS 5/356z.63)
22	22	7 Sec. 356z.63 356z.61. Coverage of pharmacy testing,
23	23	8 screening, vaccinations, and treatment.
24	24	9 (a) A group or individual policy of accident and health
25	25	10 insurance or a managed care plan that is amended, delivered,
26	26	11 issued, or renewed on or after January 1, 2025 shall provide
27	27	12 coverage for health care or patient care services provided by
28	28	13 a pharmacist if:
29	29	14 (1) the pharmacist meets the requirements and scope of
30	30	15 practice described in paragraph (15), (16), or (17) of
31	31	16 subsection (d) of Section 3 of the Pharmacy Practice Act;
32	32	17 (2) the health plan provides coverage for the same
33	33	18 service provided by a licensed physician, an advanced
34	34	19 practice registered nurse, or a physician assistant;
35	35	20 (3) the pharmacist is included in the health benefit
36	36	21 plan's network of participating providers; and
37	37	22 (4) reimbursement has been successfully negotiated in
38	38	23 good faith between the pharmacist and the health plan.
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42	42	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5462 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
43	43	215 ILCS 5/356z.63225 ILCS 85/3225 ILCS 85/20 from Ch. 111, par. 4140225 ILCS 85/24 from Ch. 111, par. 4144305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12225 ILCS 85/9.6 rep. 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.
44	44	215 ILCS 5/356z.63
45	45	225 ILCS 85/3
46	46	225 ILCS 85/20 from Ch. 111, par. 4140
47	47	225 ILCS 85/24 from Ch. 111, par. 4144
48	48	305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12
49	49	225 ILCS 85/9.6 rep.
50	50	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.
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53	53	A BILL FOR
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59	59	215 ILCS 5/356z.63
60	60	225 ILCS 85/3
61	61	225 ILCS 85/20 from Ch. 111, par. 4140
62	62	225 ILCS 85/24 from Ch. 111, par. 4144
63	63	305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12
64	64	225 ILCS 85/9.6 rep.
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83	83	1 (b) Vaccines ordered and administered by a pharmacist as
84	84	2 described in subsection (d) of Section 3 of the Pharmacy
85	85	3 Practice Act shall be covered and reimbursed at no less than
86	86	4 the rate that the vaccine is reimbursed at when ordered and
87	87	5 administered by a physician licensed to practice medicine in
88	88	6 all its branches.
89	89	7 (Source: P.A. 103-1, eff. 4-27-23; revised 8-29-23.)
90	90	8 Section 10. The Pharmacy Practice Act is amended by
91	91	9 changing Sections 3, 20, and 24 as follows:
92	92	10 (225 ILCS 85/3)
93	93	11 (Section scheduled to be repealed on January 1, 2028)
94	94	12 Sec. 3. Definitions. For the purpose of this Act, except
95	95	13 where otherwise limited therein:
96	96	14 (a) "Pharmacy" or "drugstore" means and includes every
97	97	15 store, shop, pharmacy department, or other place where
98	98	16 pharmacist care is provided by a pharmacist (1) where drugs,
99	99	17 medicines, or poisons are dispensed, sold or offered for sale
100	100	18 at retail, or displayed for sale at retail; or (2) where
101	101	19 prescriptions of physicians, dentists, advanced practice
102	102	20 registered nurses, physician assistants, veterinarians,
103	103	21 podiatric physicians, or optometrists, within the limits of
104	104	22 their licenses, are compounded, filled, or dispensed; or (3)
105	105	23 which has upon it or displayed within it, or affixed to or used
106	106	24 in connection with it, a sign bearing the word or words
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117	117	1 "Pharmacist", "Druggist", "Pharmacy", "Pharmaceutical Care",
118	118	2 "Apothecary", "Drugstore", "Medicine Store", "Prescriptions",
119	119	3 "Drugs", "Dispensary", "Medicines", or any word or words of
120	120	4 similar or like import, either in the English language or any
121	121	5 other language; or (4) where the characteristic prescription
122	122	6 sign (Rx) or similar design is exhibited; or (5) any store, or
123	123	7 shop, or other place with respect to which any of the above
124	124	8 words, objects, signs or designs are used in any
125	125	9 advertisement.
126	126	10 (b) "Drugs" means and includes (1) articles recognized in
127	127	11 the official United States Pharmacopoeia/National Formulary
128	128	12 (USP/NF), or any supplement thereto and being intended for and
129	129	13 having for their main use the diagnosis, cure, mitigation,
130	130	14 treatment or prevention of disease in man or other animals, as
131	131	15 approved by the United States Food and Drug Administration,
132	132	16 but does not include devices or their components, parts, or
133	133	17 accessories; and (2) all other articles intended for and
134	134	18 having for their main use the diagnosis, cure, mitigation,
135	135	19 treatment or prevention of disease in man or other animals, as
136	136	20 approved by the United States Food and Drug Administration,
137	137	21 but does not include devices or their components, parts, or
138	138	22 accessories; and (3) articles (other than food) having for
139	139	23 their main use and intended to affect the structure or any
140	140	24 function of the body of man or other animals; and (4) articles
141	141	25 having for their main use and intended for use as a component
142	142	26 or any articles specified in clause (1), (2) or (3); but does
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153	153	1 not include devices or their components, parts or accessories.
154	154	2 (c) "Medicines" means and includes all drugs intended for
155	155	3 human or veterinary use approved by the United States Food and
156	156	4 Drug Administration.
157	157	5 (d) "Practice of pharmacy" means:
158	158	6 (1) the interpretation and the provision of assistance
159	159	7 in the monitoring, evaluation, and implementation of
160	160	8 prescription drug orders;
161	161	9 (2) the dispensing of prescription drug orders;
162	162	10 (3) participation in drug and device selection;
163	163	11 (4) drug administration limited to the administration
164	164	12 of oral, topical, injectable, and inhalation as follows:
165	165	13 (A) in the context of patient education on the
166	166	14 proper use or delivery of medications;
167	167	15 (B) vaccination of patients 7 years of age and
168	168	16 older pursuant to a valid prescription or standing
169	169	17 order, by a physician licensed to practice medicine in
170	170	18 all its branches, except for vaccinations covered by
171	171	19 paragraph (15), upon completion of appropriate
172	172	20 training, including how to address contraindications
173	173	21 and adverse reactions set forth by rule, with
174	174	22 notification to the patient's physician and
175	175	23 appropriate record retention, or pursuant to hospital
176	176	24 pharmacy and therapeutics committee policies and
177	177	25 procedures. Eligible vaccines are those listed on the
178	178	26 U.S. Centers for Disease Control and Prevention (CDC)
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189	189	1 Recommended Immunization Schedule, the CDC's Health
190	190	2 Information for International Travel, or the U.S. Food
191	191	3 and Drug Administration's Vaccines Licensed and
192	192	4 Authorized for Use in the United States. As applicable
193	193	5 to the State's Medicaid program and other payers,
194	194	6 vaccines ordered and administered in accordance with
195	195	7 this subsection shall be covered and reimbursed at no
196	196	8 less than the rate that the vaccine is reimbursed when
197	197	9 ordered and administered by a physician;
198	198	10 (B-5) following the initial administration of
199	199	11 long-acting or extended-release form opioid
200	200	12 antagonists by a physician licensed to practice
201	201	13 medicine in all its branches, administration of
202	202	14 injections of long-acting or extended-release form
203	203	15 opioid antagonists for the treatment of substance use
204	204	16 disorder, pursuant to a valid prescription by a
205	205	17 physician licensed to practice medicine in all its
206	206	18 branches, upon completion of appropriate training,
207	207	19 including how to address contraindications and adverse
208	208	20 reactions, including, but not limited to, respiratory
209	209	21 depression and the performance of cardiopulmonary
210	210	22 resuscitation, set forth by rule, with notification to
211	211	23 the patient's physician and appropriate record
212	212	24 retention, or pursuant to hospital pharmacy and
213	213	25 therapeutics committee policies and procedures;
214	214	26 (C) administration of injections of
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225	225	1 alpha-hydroxyprogesterone caproate, pursuant to a
226	226	2 valid prescription, by a physician licensed to
227	227	3 practice medicine in all its branches, upon completion
228	228	4 of appropriate training, including how to address
229	229	5 contraindications and adverse reactions set forth by
230	230	6 rule, with notification to the patient's physician and
231	231	7 appropriate record retention, or pursuant to hospital
232	232	8 pharmacy and therapeutics committee policies and
233	233	9 procedures; and
234	234	10 (D) administration of injections of long-term
235	235	11 antipsychotic medications pursuant to a valid
236	236	12 prescription by a physician licensed to practice
237	237	13 medicine in all its branches, upon completion of
238	238	14 appropriate training conducted by an Accreditation
239	239	15 Council of Pharmaceutical Education accredited
240	240	16 provider, including how to address contraindications
241	241	17 and adverse reactions set forth by rule, with
242	242	18 notification to the patient's physician and
243	243	19 appropriate record retention, or pursuant to hospital
244	244	20 pharmacy and therapeutics committee policies and
245	245	21 procedures.
246	246	22 (5) (blank);
247	247	23 (6) drug regimen review;
248	248	24 (7) drug or drug-related research;
249	249	25 (8) the provision of patient counseling;
250	250	26 (9) the practice of telepharmacy;
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261	261	1 (10) the provision of those acts or services necessary
262	262	2 to provide pharmacist care;
263	263	3 (11) medication therapy management;
264	264	4 (12) the responsibility for compounding and labeling
265	265	5 of drugs and devices (except labeling by a manufacturer,
266	266	6 repackager, or distributor of non-prescription drugs and
267	267	7 commercially packaged legend drugs and devices), proper
268	268	8 and safe storage of drugs and devices, and maintenance of
269	269	9 required records;
270	270	10 (13) the assessment and consultation of patients and
271	271	11 dispensing of hormonal contraceptives;
272	272	12 (14) the initiation, dispensing, or administration of
273	273	13 drugs, laboratory tests, assessments, referrals, and
274	274	14 consultations for human immunodeficiency virus
275	275	15 pre-exposure prophylaxis and human immunodeficiency virus
276	276	16 post-exposure prophylaxis under Section 43.5;
277	277	17 (15) the ordering and administration of vaccines to
278	278	18 vaccination of patients 7 years of age and older for
279	279	19 COVID-19 or influenza subcutaneously, intramuscularly, or
280	280	20 orally as authorized, approved, or licensed by the United
281	281	21 States Food and Drug Administration or in accordance with
282	282	22 the United States Centers for Disease Control and
283	283	23 Prevention's Recommended Immunization Schedule or the
284	284	24 United States Centers for Disease Control and Prevention's
285	285	25 Health Information for International Travel. , pursuant to
286	286	26 the following conditions:
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297	297	1 (A) the vaccine must be authorized or licensed by
298	298	2 the United States Food and Drug Administration;
299	299	3 (B) the vaccine must be ordered and administered
300	300	4 according to the Advisory Committee on Immunization
301	301	5 Practices standard immunization schedule;
302	302	6 (C) the pharmacist must complete a course of
303	303	7 training accredited by the Accreditation Council on
304	304	8 Pharmacy Education or a similar health authority or
305	305	9 professional body approved by the Division of
306	306	10 Professional Regulation;
307	307	11 (D) the pharmacist must have a current certificate
308	308	12 in basic cardiopulmonary resuscitation;
309	309	13 (E) the pharmacist must complete, during each
310	310	14 State licensing period, a minimum of 2 hours of
311	311	15 immunization-related continuing pharmacy education
312	312	16 approved by the Accreditation Council on Pharmacy
313	313	17 Education;
314	314	18 (F) the pharmacist must comply with recordkeeping
315	315	19 and reporting requirements of the jurisdiction in
316	316	20 which the pharmacist administers vaccines, including
317	317	21 informing the patient's primary-care provider, when
318	318	22 available, and complying with requirements whereby the
319	319	23 person administering a vaccine must review the vaccine
320	320	24 registry or other vaccination records prior to
321	321	25 administering the vaccine; and
322	322	26 (G) the pharmacist must inform the pharmacist's
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333	333	1 patients who are less than 18 years old, as well as the
334	334	2 adult caregiver accompanying the child, of the
335	335	3 importance of a well-child visit with a pediatrician
336	336	4 or other licensed primary-care provider and must refer
337	337	5 patients as appropriate;
338	338	6 (16) the ordering and administration of COVID-19
339	339	7 therapeutics subcutaneously, intramuscularly, or orally
340	340	8 with notification to the patient's physician and
341	341	9 appropriate record retention or pursuant to hospital
342	342	10 pharmacy and therapeutics committee policies and
343	343	11 procedures for: (i) COVID-19 (SARS-CoV 2) or other
344	344	12 respiratory illnesses, conditions, or diseases; (ii)
345	345	13 influenza; (iii) group A Streptococcus Pharyngitis; (iv)
346	346	14 lice; (v) skin conditions, including ringworm and
347	347	15 athlete's foot; (vi) respiratory syncytial virus or RSV;
348	348	16 and (vii) other health conditions identified by a
349	349	17 statewide public health emergency, as defined in the
350	350	18 Illinois Emergency Management Agency Act. Eligible
351	351	19 therapeutics are those approved, authorized, or licensed
352	352	20 by the United States Food and Drug Administration and must
353	353	21 be administered subcutaneously, intramuscularly, or orally
354	354	22 in accordance with that approval, authorization, or
355	355	23 licensing; and
356	356	24 (17) the ordering and administration of tests and
357	357	25 screenings for (i) influenza, (ii) SARS-CoV 2 SARS-COV 2,
358	358	26 and (iii) group A Streptococcus Pharyngitis, (iv) lice,
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369	369	1 (v) skin conditions, including ringworm and athlete's
370	370	2 foot, (vi) RSV, and (vii) other health conditions
371	371	3 identified by a statewide public health emergency, as
372	372	4 defined in the Illinois Emergency Management Agency Act,
373	373	5 with notification to the patient's physician and
374	374	6 appropriate record retention or pursuant to hospital
375	375	7 pharmacy and therapeutics committee policies and
376	376	8 procedures. Eligible tests and screenings are those
377	377	9 approved, authorized, or licensed by the United States
378	378	10 Food and Drug Administration and must be administered in
379	379	11 accordance with that approval, authorization, or
380	380	12 licensing.
381	381	13 A pharmacist who orders or administers tests or
382	382	14 screenings for health conditions described in this
383	383	15 paragraph may use a test that may guide clinical
384	384	16 decision-making for the health condition that is waived
385	385	17 under the federal Clinical Laboratory Improvement
386	386	18 Amendments of 1988 and regulations promulgated thereunder
387	387	19 or any established screening procedure that is established
388	388	20 under a statewide protocol.
389	389	21 A pharmacist may delegate the administrative and
390	390	22 technical tasks of performing a test for the health
391	391	23 conditions described in this paragraph to a registered
392	392	24 pharmacy technician or student pharmacist acting under the
393	393	25 supervision of the pharmacist.
394	394	26 A pharmacist who performs any of the acts defined as the
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405	405	1 practice of pharmacy in this State must be actively licensed
406	406	2 as a pharmacist under this Act.
407	407	3 (e) "Prescription" means and includes any written, oral,
408	408	4 facsimile, or electronically transmitted order for drugs or
409	409	5 medical devices, issued by a physician licensed to practice
410	410	6 medicine in all its branches, dentist, veterinarian, podiatric
411	411	7 physician, or optometrist, within the limits of his or her
412	412	8 license, by a physician assistant in accordance with
413	413	9 subsection (f) of Section 4, or by an advanced practice
414	414	10 registered nurse in accordance with subsection (g) of Section
415	415	11 4, containing the following: (1) name of the patient; (2) date
416	416	12 when prescription was issued; (3) name and strength of drug or
417	417	13 description of the medical device prescribed; and (4)
418	418	14 quantity; (5) directions for use; (6) prescriber's name,
419	419	15 address, and signature; and (7) DEA registration number where
420	420	16 required, for controlled substances. The prescription may, but
421	421	17 is not required to, list the illness, disease, or condition
422	422	18 for which the drug or device is being prescribed. DEA
423	423	19 registration numbers shall not be required on inpatient drug
424	424	20 orders. A prescription for medication other than controlled
425	425	21 substances shall be valid for up to 15 months from the date
426	426	22 issued for the purpose of refills, unless the prescription
427	427	23 states otherwise.
428	428	24 (f) "Person" means and includes a natural person,
429	429	25 partnership, association, corporation, government entity, or
430	430	26 any other legal entity.
431	431
432	432
433	433
434	434
435	435
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437	437
438	438
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440	440	HB5462 - 12 - LRB103 38877 RTM 69014 b
441	441	1 (g) "Department" means the Department of Financial and
442	442	2 Professional Regulation.
443	443	3 (h) "Board of Pharmacy" or "Board" means the State Board
444	444	4 of Pharmacy of the Department of Financial and Professional
445	445	5 Regulation.
446	446	6 (i) "Secretary" means the Secretary of Financial and
447	447	7 Professional Regulation.
448	448	8 (j) "Drug product selection" means the interchange for a
449	449	9 prescribed pharmaceutical product in accordance with Section
450	450	10 25 of this Act and Section 3.14 of the Illinois Food, Drug and
451	451	11 Cosmetic Act.
452	452	12 (k) "Inpatient drug order" means an order issued by an
453	453	13 authorized prescriber for a resident or patient of a facility
454	454	14 licensed under the Nursing Home Care Act, the ID/DD Community
455	455	15 Care Act, the MC/DD Act, the Specialized Mental Health
456	456	16 Rehabilitation Act of 2013, the Hospital Licensing Act, or the
457	457	17 University of Illinois Hospital Act, or a facility which is
458	458	18 operated by the Department of Human Services (as successor to
459	459	19 the Department of Mental Health and Developmental
460	460	20 Disabilities) or the Department of Corrections.
461	461	21 (k-5) "Pharmacist" means an individual health care
462	462	22 professional and provider currently licensed by this State to
463	463	23 engage in the practice of pharmacy.
464	464	24 (l) "Pharmacist in charge" means the licensed pharmacist
465	465	25 whose name appears on a pharmacy license and who is
466	466	26 responsible for all aspects of the operation related to the
467	467
468	468
469	469
470	470
471	471
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473	473
474	474
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476	476	HB5462 - 13 - LRB103 38877 RTM 69014 b
477	477	1 practice of pharmacy.
478	478	2 (m) "Dispense" or "dispensing" means the interpretation,
479	479	3 evaluation, and implementation of a prescription drug order,
480	480	4 including the preparation and delivery of a drug or device to a
481	481	5 patient or patient's agent in a suitable container
482	482	6 appropriately labeled for subsequent administration to or use
483	483	7 by a patient in accordance with applicable State and federal
484	484	8 laws and regulations. "Dispense" or "dispensing" does not mean
485	485	9 the physical delivery to a patient or a patient's
486	486	10 representative in a home or institution by a designee of a
487	487	11 pharmacist or by common carrier. "Dispense" or "dispensing"
488	488	12 also does not mean the physical delivery of a drug or medical
489	489	13 device to a patient or patient's representative by a
490	490	14 pharmacist's designee within a pharmacy or drugstore while the
491	491	15 pharmacist is on duty and the pharmacy is open.
492	492	16 (n) "Nonresident pharmacy" means a pharmacy that is
493	493	17 located in a state, commonwealth, or territory of the United
494	494	18 States, other than Illinois, that delivers, dispenses, or
495	495	19 distributes, through the United States Postal Service,
496	496	20 commercially acceptable parcel delivery service, or other
497	497	21 common carrier, to Illinois residents, any substance which
498	498	22 requires a prescription.
499	499	23 (o) "Compounding" means the preparation and mixing of
500	500	24 components, excluding flavorings, (1) as the result of a
501	501	25 prescriber's prescription drug order or initiative based on
502	502	26 the prescriber-patient-pharmacist relationship in the course
503	503
504	504
505	505
506	506
507	507
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509	509
510	510
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512	512	HB5462 - 14 - LRB103 38877 RTM 69014 b
513	513	1 of professional practice or (2) for the purpose of, or
514	514	2 incident to, research, teaching, or chemical analysis and not
515	515	3 for sale or dispensing. "Compounding" includes the preparation
516	516	4 of drugs or devices in anticipation of receiving prescription
517	517	5 drug orders based on routine, regularly observed dispensing
518	518	6 patterns. Commercially available products may be compounded
519	519	7 for dispensing to individual patients only if all of the
520	520	8 following conditions are met: (i) the commercial product is
521	521	9 not reasonably available from normal distribution channels in
522	522	10 a timely manner to meet the patient's needs and (ii) the
523	523	11 prescribing practitioner has requested that the drug be
524	524	12 compounded.
525	525	13 (p) (Blank).
526	526	14 (q) (Blank).
527	527	15 (r) "Patient counseling" means the communication between a
528	528	16 pharmacist or a student pharmacist under the supervision of a
529	529	17 pharmacist and a patient or the patient's representative about
530	530	18 the patient's medication or device for the purpose of
531	531	19 optimizing proper use of prescription medications or devices.
532	532	20 "Patient counseling" may include without limitation (1)
533	533	21 obtaining a medication history; (2) acquiring a patient's
534	534	22 allergies and health conditions; (3) facilitation of the
535	535	23 patient's understanding of the intended use of the medication;
536	536	24 (4) proper directions for use; (5) significant potential
537	537	25 adverse events; (6) potential food-drug interactions; and (7)
538	538	26 the need to be compliant with the medication therapy. A
539	539
540	540
541	541
542	542
543	543
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545	545
546	546
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548	548	HB5462 - 15 - LRB103 38877 RTM 69014 b
549	549	1 pharmacy technician may only participate in the following
550	550	2 aspects of patient counseling under the supervision of a
551	551	3 pharmacist: (1) obtaining medication history; (2) providing
552	552	4 the offer for counseling by a pharmacist or student
553	553	5 pharmacist; and (3) acquiring a patient's allergies and health
554	554	6 conditions.
555	555	7 (s) "Patient profiles" or "patient drug therapy record"
556	556	8 means the obtaining, recording, and maintenance of patient
557	557	9 prescription information, including prescriptions for
558	558	10 controlled substances, and personal information.
559	559	11 (t) (Blank).
560	560	12 (u) "Medical device" or "device" means an instrument,
561	561	13 apparatus, implement, machine, contrivance, implant, in vitro
562	562	14 reagent, or other similar or related article, including any
563	563	15 component part or accessory, required under federal law to
564	564	16 bear the label "Caution: Federal law requires dispensing by or
565	565	17 on the order of a physician". A seller of goods and services
566	566	18 who, only for the purpose of retail sales, compounds, sells,
567	567	19 rents, or leases medical devices shall not, by reasons
568	568	20 thereof, be required to be a licensed pharmacy.
569	569	21 (v) "Unique identifier" means an electronic signature,
570	570	22 handwritten signature or initials, thumb print, or other
571	571	23 acceptable biometric or electronic identification process as
572	572	24 approved by the Department.
573	573	25 (w) "Current usual and customary retail price" means the
574	574	26 price that a pharmacy charges to a non-third-party payor.
575	575
576	576
577	577
578	578
579	579
580	580	HB5462 - 15 - LRB103 38877 RTM 69014 b
581	581
582	582
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584	584	HB5462 - 16 - LRB103 38877 RTM 69014 b
585	585	1 (x) "Automated pharmacy system" means a mechanical system
586	586	2 located within the confines of the pharmacy or remote location
587	587	3 that performs operations or activities, other than compounding
588	588	4 or administration, relative to storage, packaging, dispensing,
589	589	5 or distribution of medication, and which collects, controls,
590	590	6 and maintains all transaction information.
591	591	7 (y) "Drug regimen review" means and includes the
592	592	8 evaluation of prescription drug orders and patient records for
593	593	9 (1) known allergies; (2) drug or potential therapy
594	594	10 contraindications; (3) reasonable dose, duration of use, and
595	595	11 route of administration, taking into consideration factors
596	596	12 such as age, gender, and contraindications; (4) reasonable
597	597	13 directions for use; (5) potential or actual adverse drug
598	598	14 reactions; (6) drug-drug interactions; (7) drug-food
599	599	15 interactions; (8) drug-disease contraindications; (9)
600	600	16 therapeutic duplication; (10) patient laboratory values when
601	601	17 authorized and available; (11) proper utilization (including
602	602	18 over or under utilization) and optimum therapeutic outcomes;
603	603	19 and (12) abuse and misuse.
604	604	20 (z) "Electronically transmitted prescription" means a
605	605	21 prescription that is created, recorded, or stored by
606	606	22 electronic means; issued and validated with an electronic
607	607	23 signature; and transmitted by electronic means directly from
608	608	24 the prescriber to a pharmacy. An electronic prescription is
609	609	25 not an image of a physical prescription that is transferred by
610	610	26 electronic means from computer to computer, facsimile to
611	611
612	612
613	613
614	614
615	615
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617	617
618	618
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620	620	HB5462 - 17 - LRB103 38877 RTM 69014 b
621	621	1 facsimile, or facsimile to computer.
622	622	2 (aa) "Medication therapy management services" means a
623	623	3 distinct service or group of services offered by licensed
624	624	4 pharmacists, physicians licensed to practice medicine in all
625	625	5 its branches, advanced practice registered nurses authorized
626	626	6 in a written agreement with a physician licensed to practice
627	627	7 medicine in all its branches, or physician assistants
628	628	8 authorized in guidelines by a supervising physician that
629	629	9 optimize therapeutic outcomes for individual patients through
630	630	10 improved medication use. In a retail or other non-hospital
631	631	11 pharmacy, medication therapy management services shall consist
632	632	12 of the evaluation of prescription drug orders and patient
633	633	13 medication records to resolve conflicts with the following:
634	634	14 (1) known allergies;
635	635	15 (2) drug or potential therapy contraindications;
636	636	16 (3) reasonable dose, duration of use, and route of
637	637	17 administration, taking into consideration factors such as
638	638	18 age, gender, and contraindications;
639	639	19 (4) reasonable directions for use;
640	640	20 (5) potential or actual adverse drug reactions;
641	641	21 (6) drug-drug interactions;
642	642	22 (7) drug-food interactions;
643	643	23 (8) drug-disease contraindications;
644	644	24 (9) identification of therapeutic duplication;
645	645	25 (10) patient laboratory values when authorized and
646	646	26 available;
647	647
648	648
649	649
650	650
651	651
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653	653
654	654
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656	656	HB5462 - 18 - LRB103 38877 RTM 69014 b
657	657	1 (11) proper utilization (including over or under
658	658	2 utilization) and optimum therapeutic outcomes; and
659	659	3 (12) drug abuse and misuse.
660	660	4 "Medication therapy management services" includes the
661	661	5 following:
662	662	6 (1) documenting the services delivered and
663	663	7 communicating the information provided to patients'
664	664	8 prescribers within an appropriate time frame, not to
665	665	9 exceed 48 hours;
666	666	10 (2) providing patient counseling designed to enhance a
667	667	11 patient's understanding and the appropriate use of his or
668	668	12 her medications; and
669	669	13 (3) providing information, support services, and
670	670	14 resources designed to enhance a patient's adherence with
671	671	15 his or her prescribed therapeutic regimens.
672	672	16 "Medication therapy management services" may also include
673	673	17 patient care functions authorized by a physician licensed to
674	674	18 practice medicine in all its branches for his or her
675	675	19 identified patient or groups of patients under specified
676	676	20 conditions or limitations in a standing order from the
677	677	21 physician.
678	678	22 "Medication therapy management services" in a licensed
679	679	23 hospital may also include the following:
680	680	24 (1) reviewing assessments of the patient's health
681	681	25 status; and
682	682	26 (2) following protocols of a hospital pharmacy and
683	683
684	684
685	685
686	686
687	687
688	688	HB5462 - 18 - LRB103 38877 RTM 69014 b
689	689
690	690
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692	692	HB5462 - 19 - LRB103 38877 RTM 69014 b
693	693	1 therapeutics committee with respect to the fulfillment of
694	694	2 medication orders.
695	695	3 (bb) "Pharmacist care" means the provision by a pharmacist
696	696	4 of medication therapy management services, with or without the
697	697	5 dispensing of drugs or devices, intended to achieve outcomes
698	698	6 that improve patient health, quality of life, and comfort and
699	699	7 enhance patient safety.
700	700	8 (cc) "Protected health information" means individually
701	701	9 identifiable health information that, except as otherwise
702	702	10 provided, is:
703	703	11 (1) transmitted by electronic media;
704	704	12 (2) maintained in any medium set forth in the
705	705	13 definition of "electronic media" in the federal Health
706	706	14 Insurance Portability and Accountability Act; or
707	707	15 (3) transmitted or maintained in any other form or
708	708	16 medium.
709	709	17 "Protected health information" does not include
710	710	18 individually identifiable health information found in:
711	711	19 (1) education records covered by the federal Family
712	712	20 Educational Right and Privacy Act; or
713	713	21 (2) employment records held by a licensee in its role
714	714	22 as an employer.
715	715	23 (dd) "Standing order" means a specific order for a patient
716	716	24 or group of patients issued by a physician licensed to
717	717	25 practice medicine in all its branches in Illinois.
718	718	26 (ee) "Address of record" means the designated address
719	719
720	720
721	721
722	722
723	723
724	724	HB5462 - 19 - LRB103 38877 RTM 69014 b
725	725
726	726
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728	728	HB5462 - 20 - LRB103 38877 RTM 69014 b
729	729	1 recorded by the Department in the applicant's application file
730	730	2 or licensee's license file maintained by the Department's
731	731	3 licensure maintenance unit.
732	732	4 (ff) "Home pharmacy" means the location of a pharmacy's
733	733	5 primary operations.
734	734	6 (gg) "Email address of record" means the designated email
735	735	7 address recorded by the Department in the applicant's
736	736	8 application file or the licensee's license file, as maintained
737	737	9 by the Department's licensure maintenance unit.
738	738	10 (Source: P.A. 102-16, eff. 6-17-21; 102-103, eff. 1-1-22;
739	739	11 102-558, eff. 8-20-21; 102-813, eff. 5-13-22; 102-1051, eff.
740	740	12 1-1-23; 103-1, eff. 4-27-23.)
741	741	13 (225 ILCS 85/20) (from Ch. 111, par. 4140)
742	742	14 (Section scheduled to be repealed on January 1, 2028)
743	743	15 Sec. 20. Dispensing systems.
744	744	16 (a) Two or more pharmacies may establish and use a common
745	745	17 electronic file to maintain required dispensing information.
746	746	18 (b) Pharmacies using such a common electronic file are not
747	747	19 required to physically transfer prescriptions or information
748	748	20 for dispensing purposes between or among pharmacies
749	749	21 participating in the same common prescription file; provided,
750	750	22 however any such common file must contain complete and
751	751	23 adequate records of such prescription and refill dispensed as
752	752	24 stated in Section 18.
753	753	25 (c) The Department may formulate such rules, not
754	754
755	755
756	756
757	757
758	758
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760	760
761	761
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763	763	HB5462 - 21 - LRB103 38877 RTM 69014 b
764	764	1 inconsistent with law, as may be necessary to carry out the
765	765	2 purposes of and to enforce the provisions of this Section
766	766	3 within the following exception: The Department shall not
767	767	4 impose greater requirements on either common electronic files
768	768	5 or a hard copy record system.
769	769	6 (d) Drugs shall in no event be dispensed more frequently
770	770	7 or in larger amounts than the prescriber ordered without
771	771	8 direct prescriber authorization by way of a new prescription
772	772	9 order.
773	773	10 (e) The dispensing by a pharmacist licensed in this State
774	774	11 or another state of a prescription contained in a common
775	775	12 database shall not constitute a transfer, provided that (1)
776	776	13 all pharmacies involved in the transactions pursuant to which
777	777	14 the prescription is dispensed and all pharmacists engaging in
778	778	15 dispensing functions are properly licensed, permitted, or
779	779	16 registered in this State or another jurisdiction, (2) a policy
780	780	17 and procedures manual that governs all participating
781	781	18 pharmacies and pharmacists is available to the Department upon
782	782	19 request and includes the procedure for maintaining appropriate
783	783	20 records for regulatory oversight for tracking a prescription
784	784	21 during each stage of the filling and dispensing process, and
785	785	22 (3) the pharmacists involved in filling and dispensing the
786	786	23 prescription and counseling the patient are identified. A
787	787	24 pharmacist shall be accountable only for the specific tasks
788	788	25 performed.
789	789	26 (f) Nothing in this Section shall prohibit a pharmacist
790	790
791	791
792	792
793	793
794	794
795	795	HB5462 - 21 - LRB103 38877 RTM 69014 b
796	796
797	797
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799	799	HB5462 - 22 - LRB103 38877 RTM 69014 b
800	800	1 who is exercising his or her professional judgment from
801	801	2 dispensing additional quantities of medication up to the total
802	802	3 number of dosage units authorized by the prescriber on the
803	803	4 original prescription and any refills.
804	804	5 (g) A pharmacist who is exercising his or her professional
805	805	6 judgment may change the quantity of medication prescribed if:
806	806	7 (1) the prescribed quantity or package size is not
807	807	8 commercially available;
808	808	9 (2) the change in quantity is related to a change in
809	809	10 dosage form, strength, or therapeutic interchange;
810	810	11 (3) the change extends a maintenance drug for the
811	811	12 limited quantity necessary to coordinate a patient's
812	812	13 refills in a medication synchronization program; and
813	813	14 (4) the change to add missing non-pharmaceutical
814	814	15 devices or durable medical equipment that aid in the
815	815	16 appropriate clinical usage of a medication or achieving a
816	816	17 positive therapeutic outcome.
817	817	18 A pharmacist may change the dosage form of a prescription
818	818	19 if it is in the best interest of patient care, so long as the
819	819	20 prescriber's directions are also modified to equate to an
820	820	21 equivalent amount of drug dispensed as prescribed.
821	821	22 A pharmacist may complete missing information on a
822	822	23 prescription if evidence supports the change.
823	823	24 The change must be documented in the patient's record.
824	824	25 (Source: P.A. 100-497, eff. 9-8-17.)
825	825
826	826
827	827
828	828
829	829
830	830	HB5462 - 22 - LRB103 38877 RTM 69014 b
831	831
832	832
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834	834	HB5462 - 23 - LRB103 38877 RTM 69014 b
835	835	1 (225 ILCS 85/24) (from Ch. 111, par. 4144)
836	836	2 (Section scheduled to be repealed on January 1, 2028)
837	837	3 Sec. 24. It shall be unlawful for any manufacturer or
838	838	4 distributor of a prescription drug, or any person on behalf of
839	839	5 such manufacturer or distributor, to distribute a prescription
840	840	6 drug without charge or for less than its fair market value to
841	841	7 any person directly or indirectly.
842	842	8 Nothing in this Section shall be construed to prohibit the
843	843	9 distribution of a prescription drug:
844	844	10 (a) at a discount in accordance with the laws of the
845	845	11 United States or the State of Illinois;
846	846	12 (b) to a person for use in an investigation conducted
847	847	13 under Federal Food and Drug Administration regulations;
848	848	14 (c) to a patient by a pharmacist in response to a
849	849	15 request written and signed by a medical practitioner which
850	850	16 designates the quantity to be distributed;
851	851	17 (d) to a licensed medical practitioner in response to
852	852	18 a request signed by the practitioner which designates the
853	853	19 quantity to be distributed;
854	854	20 (e) to an agency of the federal government or to a
855	855	21 state government or political subdivision for regulatory
856	856	22 or enforcement purposes;
857	857	23 (f) in an emergency as determined by the laws of the
858	858	24 United States or the State of Illinois; or
859	859	25 (g) to a bona fide charity authorized to possess and
860	860	26 dispense prescription drugs.
861	861
862	862
863	863
864	864
865	865
866	866	HB5462 - 23 - LRB103 38877 RTM 69014 b
867	867
868	868
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870	870	HB5462 - 24 - LRB103 38877 RTM 69014 b
871	871	1 It shall be unlawful to require a pharmacist or pharmacy
872	872	2 to dispense a prescription drug below fair market value,
873	873	3 including the cost of dispensing. Any payor that reimburses a
874	874	4 pharmacy below fair market value, including the cost of
875	875	5 dispensing, shall not be able to include this pharmacy towards
876	876	6 any network adequacy requirements and shall not be in
877	877	7 compliance with any willing provider provisions.
878	878	8 (Source: P.A. 85-796.)
879	879	9 Section 15. The Illinois Public Aid Code is amended by
880	880	10 changing Section 5-5.12 as follows:
881	881	11 (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
882	882	12 Sec. 5-5.12. Pharmacy payments.
883	883	13 (a) Every request submitted by a pharmacy for
884	884	14 reimbursement under this Article for prescription drugs
885	885	15 provided to a recipient of aid under this Article shall
886	886	16 include the name of the prescriber or an acceptable
887	887	17 identification number as established by the Department.
888	888	18 (b) Pharmacies providing prescription drugs under this
889	889	19 Article shall be reimbursed at a rate which shall include a
890	890	20 professional dispensing fee as determined by the Illinois
891	891	21 Department, plus the current acquisition cost of the
892	892	22 prescription drug dispensed. The Illinois Department shall
893	893	23 update its information on the acquisition costs of all
894	894	24 prescription drugs no less frequently than every 30 days.
895	895
896	896
897	897
898	898
899	899
900	900	HB5462 - 24 - LRB103 38877 RTM 69014 b
901	901
902	902
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904	904	HB5462 - 25 - LRB103 38877 RTM 69014 b
905	905	1 However, the Illinois Department may set the rate of
906	906	2 reimbursement for the acquisition cost, by rule, at a
907	907	3 percentage of the current average wholesale acquisition cost.
908	908	4 (c) (Blank).
909	909	5 (d) The Department shall review utilization of narcotic
910	910	6 medications in the medical assistance program and impose
911	911	7 utilization controls that protect against abuse.
912	912	8 (e) When making determinations as to which drugs shall be
913	913	9 on a prior approval list, the Department shall include as part
914	914	10 of the analysis for this determination, the degree to which a
915	915	11 drug may affect individuals in different ways based on factors
916	916	12 including the gender of the person taking the medication.
917	917	13 (f) The Department shall cooperate with the Department of
918	918	14 Public Health and the Department of Human Services Division of
919	919	15 Mental Health in identifying psychotropic medications that,
920	920	16 when given in a particular form, manner, duration, or
921	921	17 frequency (including "as needed") in a dosage, or in
922	922	18 conjunction with other psychotropic medications to a nursing
923	923	19 home resident or to a resident of a facility licensed under the
924	924	20 ID/DD Community Care Act or the MC/DD Act, may constitute a
925	925	21 chemical restraint or an "unnecessary drug" as defined by the
926	926	22 Nursing Home Care Act or Titles XVIII and XIX of the Social
927	927	23 Security Act and the implementing rules and regulations. The
928	928	24 Department shall require prior approval for any such
929	929	25 medication prescribed for a nursing home resident or to a
930	930	26 resident of a facility licensed under the ID/DD Community Care
931	931
932	932
933	933
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941	941	1 Act or the MC/DD Act, that appears to be a chemical restraint
942	942	2 or an unnecessary drug. The Department shall consult with the
943	943	3 Department of Human Services Division of Mental Health in
944	944	4 developing a protocol and criteria for deciding whether to
945	945	5 grant such prior approval.
946	946	6 (g) The Department may by rule provide for reimbursement
947	947	7 of the dispensing of a 90-day supply of a generic or brand
948	948	8 name, non-narcotic maintenance medication in circumstances
949	949	9 where it is cost effective.
950	950	10 (g-5) On and after July 1, 2012, the Department may
951	951	11 require the dispensing of drugs to nursing home residents be
952	952	12 in a 7-day supply or other amount less than a 31-day supply.
953	953	13 The Department shall pay only one dispensing fee per 31-day
954	954	14 supply.
955	955	15 (h) Effective July 1, 2011, the Department shall
956	956	16 discontinue coverage of select over-the-counter drugs,
957	957	17 including analgesics and cough and cold and allergy
958	958	18 medications.
959	959	19 (h-5) On and after July 1, 2012, the Department shall
960	960	20 impose utilization controls, including, but not limited to,
961	961	21 prior approval on specialty drugs, oncolytic drugs, drugs for
962	962	22 the treatment of HIV or AIDS, immunosuppressant drugs, and
963	963	23 biological products in order to maximize savings on these
964	964	24 drugs. The Department may adjust payment methodologies for
965	965	25 non-pharmacy billed drugs in order to incentivize the
966	966	26 selection of lower-cost drugs. For drugs for the treatment of
967	967
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977	977	1 AIDS, the Department shall take into consideration the
978	978	2 potential for non-adherence by certain populations, and shall
979	979	3 develop protocols with organizations or providers primarily
980	980	4 serving those with HIV/AIDS, as long as such measures intend
981	981	5 to maintain cost neutrality with other utilization management
982	982	6 controls such as prior approval. For hemophilia, the
983	983	7 Department shall develop a program of utilization review and
984	984	8 control which may include, in the discretion of the
985	985	9 Department, prior approvals. The Department may impose special
986	986	10 standards on providers that dispense blood factors which shall
987	987	11 include, in the discretion of the Department, staff training
988	988	12 and education; patient outreach and education; case
989	989	13 management; in-home patient assessments; assay management;
990	990	14 maintenance of stock; emergency dispensing timeframes; data
991	991	15 collection and reporting; dispensing of supplies related to
992	992	16 blood factor infusions; cold chain management and packaging
993	993	17 practices; care coordination; product recalls; and emergency
994	994	18 clinical consultation. The Department may require patients to
995	995	19 receive a comprehensive examination annually at an appropriate
996	996	20 provider in order to be eligible to continue to receive blood
997	997	21 factor.
998	998	22 (i) On and after July 1, 2012, the Department shall reduce
999	999	23 any rate of reimbursement for services or other payments or
1000	1000	24 alter any methodologies authorized by this Code to reduce any
1001	1001	25 rate of reimbursement for services or other payments in
1002	1002	26 accordance with Section 5-5e.
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1013	1013	1 (j) On and after July 1, 2012, the Department shall impose
1014	1014	2 limitations on prescription drugs such that the Department
1015	1015	3 shall not provide reimbursement for more than 4 prescriptions,
1016	1016	4 including 3 brand name prescriptions, for distinct drugs in a
1017	1017	5 30-day period, unless prior approval is received for all
1018	1018	6 prescriptions in excess of the 4-prescription limit. Drugs in
1019	1019	7 the following therapeutic classes shall not be subject to
1020	1020	8 prior approval as a result of the 4-prescription limit:
1021	1021	9 immunosuppressant drugs, oncolytic drugs, anti-retroviral
1022	1022	10 drugs, and, on or after July 1, 2014, antipsychotic drugs. On
1023	1023	11 or after July 1, 2014, the Department may exempt children with
1024	1024	12 complex medical needs enrolled in a care coordination entity
1025	1025	13 contracted with the Department to solely coordinate care for
1026	1026	14 such children, if the Department determines that the entity
1027	1027	15 has a comprehensive drug reconciliation program.
1028	1028	16 (k) No medication therapy management program implemented
1029	1029	17 by the Department shall be contrary to the provisions of the
1030	1030	18 Pharmacy Practice Act.
1031	1031	19 (l) Any provider enrolled with the Department that bills
1032	1032	20 the Department for outpatient drugs and is eligible to enroll
1033	1033	21 in the federal Drug Pricing Program under Section 340B of the
1034	1034	22 federal Public Health Service Act shall enroll in that
1035	1035	23 program. No entity participating in the federal Drug Pricing
1036	1036	24 Program under Section 340B of the federal Public Health
1037	1037	25 Service Act may exclude fee-for-service Medicaid from their
1038	1038	26 participation in that program, however, entities defined in
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1049	1049	1 Section 1905(l)(2)(B) of the Social Security Act are excluded
1050	1050	2 from this requirement. This subsection does not apply to
1051	1051	3 outpatient drugs billed to Medicaid managed care
1052	1052	4 organizations.
1053	1053	5 (m) Notwithstanding any other provision of this Code to
1054	1054	6 the contrary, vaccines ordered and administered by a
1055	1055	7 pharmacist as described in
1056	1056	subsection (d) of Section 3 of the
1057	1057	8 Pharmacy Practice Act shall be covered and reimbursed at no
1058	1058	9 less than the rate that the vaccine is reimbursed at when
1059	1059	10 ordered and administered by a physician licensed to practice
1060	1060	11 medicine in all its branches.
1061	1061	12 (Source: P.A. 102-558, eff. 8-20-21; 102-778, eff. 7-1-22.)
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