IL SB0737

Amends Section 5-5.12 of the Illinois Public Aid Code regarding pharmacy reimbursement rates and prescription drug coverage under medical assistance.

Requires pharmacies to include prescriber name or identification number on reimbursement requests and establishes reimbursement based on professional dispensing fee plus current acquisition cost, with acquisition cost information updated at least every 30 days.

Imposes a 4-prescription limit per 30-day period (including maximum 3 brand name drugs) effective July 1, 2012, with exemptions for immunosuppressant drugs, oncolytic drugs, anti-retroviral drugs, and anti-epileptic drugs used to treat epilepsy or seizure disorders.

Establishes utilization controls for narcotic medications, specialty drugs, HIV/AIDS drugs, and psychotropic medications in nursing homes and ID/DD facilities, with requirements for prior approval of potentially problematic medications.

Requires providers billing for outpatient drugs who are eligible for the federal Drug Pricing Program under Section 340B must enroll in that program and cannot exclude Medicaid from participation.