IllinoisMedicaid managed care plans would match fee-for-service pharmacy payments
If enacted, Medicaid managed care organizations would have to meet fee-for-service payment levels when reimbursing most pharmacies for covered services.
What it does
If enacted, Medicaid managed care plans would have to pay most pharmacies at least the fee-for-service amounts for dispensing and acquiring covered drugs, whether plans pay directly or use a pharmacy benefit manager.
Argument forA payment floor could help most participating pharmacies receive at least the fee-for-service amounts for covered Medicaid prescriptions.
Argument againstRequiring plans to meet the fee-for-service floor could reduce flexibility for managed care organizations and their pharmacy benefit managers when negotiating payments.
More detail
Medicaid managed care organizations would have to reimburse most pharmacy providers for dispensing fees and drug acquisition costs at least as much as the fee-for-service program pays. The rule covers pharmacy services for people receiving benefits under the Illinois Public Aid Code, including services reimbursed under Section 5-36. It would apply when the managed care organization pays the pharmacy directly or uses a pharmacy benefit manager. It would not cover a pharmacy provider that is a critical access care pharmacy. The supplied text does not state when this payment rule would take effect.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 4Added Co-Sponsor Rep. Theresa MahLatest
- Sep 4Added Co-Sponsor Rep. Maurice A. West, II
- Jul 22Filed with the Clerk by Rep. Dave VellaIntroduced
HealthcareConsumer ProtectionMental Health