This change was recently discussed at the General Assembly's Joint Committee on Administrative Rules' November meeting.
The final rule will appear in the December 7, 2012 edition of the Illinois Register.
Issue 33 of JCAR's Illinois Register (PDF page 94) contained the actual updated language that states reimbursement for physician-dispensed prescriptions is based on the original manufacturer's NDC code, not the repackaged NDC code:
10) Prescriptions
A) This schedule applies to prescriptions filled and dispensed outside of a licensed pharmacy.
B) Prescriptions shall be billed at the Average Wholesale Price, plus a dispensing fee of $4.18. [820 ILCS 305/8.2(a-3)]
C) Average Wholesale Price or its equivalent as registered by the National Drug Code shall be set forth for that drug on that date as published in Medispan. [820 ILCS 305/8.2(a-3)]
D) If a prescription has been repackaged, the Average Wholesale Price used to determine the maximum reimbursement shall be the Average Wholesale Price for the underlying drug product, as identified by its National Drug Code from the original labeler.
Here is CA we saw a swift towards compound pharmaceuticals after our re packed drugs laws reformed and controlled. Do you anticipate similar swings?
ReplyDeleteActually, the IL Workers' Compensation Commission's Medical Fee Advisory Board has compounded pharmaceuticals on its December meeting agenda this Wednesday. We should have a follow-up posted after that meeting.
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