HB 3203, legislation that authorizes pharmacists or retailers to sell fentanyl test strips over the counter and authorizes county health departments to distribute fentanyl test strings at their facilities for no fee was signed by Gov. JB Pritzker (D) on August 4th and goes into effect January 1, 2024.  

Also signed by Gov. Pritzker (D) on August 4th was HB 3631, legislation that prohibits a pharmacy benefit manager (PBM) from retaliating against a pharmacist or pharmacy for disclosing information in a court, administrative hearing, before a legislative commission or committee, or any proceeding, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of state or federal law, rule or regulation. The bill also prohibits a PBM from retaliating against a pharmacist or pharmacy for disclosing information to a government or law enforcement agency, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of state or federal law, rule, or regulation. A pharmacist or pharmacy must make reasonable efforts to limit the disclosure of confidential and proprietary information. This measure went into effect July 1, 2023.  

Also in Illinois, the Illinois Department of Healthcare and Family Services (HFS) has issued notice that implements Public Act 102-1051 which allows pharmacists to be reimbursed for human immunodeficiency virus (HIV) pre- and post-exposure prophylaxis assessment and consultation. This new policy is effective with dates of service on and after January 1, 2023, and applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCOs). 

In accordance with the Act, the Department of Healthcare and Family Services (HFS) will cover patient care services provided by a pharmacist for HIV pre- and post-exposure prophylaxis assessment and consultation at 85% of the physician rate. Pharmacists must have a standing order with an associated physician, be licensed to practice medicine in all its branches and be enrolled in the Illinois Medical Assistance Program to perform the assessment and consultation services.  

HFS has also issued notice informing pharmacies that HFS has opened additional procedure codes that may be billed for pharmacists providing hormonal contraceptive assessment and consultation services. This applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organization (MCO) plans. 

By provider notice dated October 31, 2022, the Department of Healthcare and Family Services (HFS) notified providers that patient care services provided by a pharmacist for hormonal contraceptive assessment and consultation would be covered at 85% of the physician rate. HFS identified CPT procedure code 99401 – Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes, for billing. Modifier FP must be billed in conjunction with procedure code 99401.  

Effective retroactive to August 1, 2022, pharmacies may bill on behalf of pharmacists for one of the following Evaluation and Management procedure codes with the FP modifier, in addition to 99401, for the assessment component of the family planning service. 

HFS has been notified of an extreme shortage of Cisplatin, which has been determined to constitute a medical emergency for those patients in need. In accordance with the actions by the Food and Drug Administration (FDA), a non-FDA approved Cisplatin, manufactured by Qilu Pharmaceutical Company in conjunction with Apotex Corporation, can be distributed into and within the State of Illinois and will be reimbursable for Illinois Medicaid enrolled providers. Additional information can be found here. 

Finally in Illinois, Snap EBT (Electronic Benefit Transfer) data theft has been on the rise in stores across the Country. The Department of Human Services (IDHS) has confirmed a recent surge in compromised cards in Illinois. Retailers are urged to immediately contact their POS (Point of Sale) vendor, local police, FNS and IDHS if skimming devices are discovered, or your pin pads have been compromised in any way. With prompt notification, IDHS can move to protect cardholders before their benefits are stolen. Tracking skimming after the theft is exceedingly difficult to do. Contact IDHS at: dhs.ebtretailer.reportfraud@illinois.gov  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.