IL SB3482

Department of Healthcare and Family Services must promulgate regulations by November 1, 2012 defining criteria for granting prior authorization for non-preferred medications under Medicaid.

Regulations must establish criteria for denying prior authorization requests and criteria for managed care entities administering pharmaceutical drug benefits.

Department must define circumstances where prior authorization will be waived for specific medical conditions and drug classes, and establish an expedited appeal procedure for emergency situations.

Regulations must include safeguard provisions ensuring continued benefits when prescribers fail to request prior authorization, with written notice and appeal procedures.

Department must consult with Medicaid recipients, health care advocates (including mental health advocates), and providers before promulgating regulations, and may use expedited rulemaking procedures.