HR0746 104TH GENERAL ASSEMBLY

HR0746 LRB104 21206 RMO 35716 r

HOUSE RESOLUTION

WHEREAS, The Medicaid program administered by the Illinois Department of Healthcare and Family Services (HFS) provides health coverage to more than three million Illinois residents, including low-income families, seniors, individuals with disabilities, and children; and

WHEREAS, Community pharmacies serve as one of the most accessible health care providers for Medicaid recipients, ensuring access to life-saving medications, medication therapy management, clinical consultation, and pharmacist-provided patient care services; and

WHEREAS, The Medicaid fee-for-service (FFS) pharmacy reimbursement methodology is designed to reimburse pharmacies using transparent ingredient cost benchmarks along with a professional dispensing fee, which reflects the cost of safely dispensing medications, including pharmacist review, drug utilization review, compliance with federal and state regulatory requirements, patient counseling, and maintaining pharmacy operations; and

WHEREAS, Under the Medicaid managed care system, pharmacy reimbursement is frequently determined through contracts between managed care organizations (MCOs) and pharmacy benefit managers (PBMs), which may reimburse pharmacies at rates that differ from the Medicaid FFS methodology, creating payment instability and uncertainty for pharmacy providers; and

WHEREAS, Reimbursement below the Medicaid FFS benchmark can create financial pressure on pharmacies serving Medicaid beneficiaries, particularly independent pharmacies and pharmacies located in rural and underserved communities; and

WHEREAS, Numerous states have identified cost savings and improved transparency when Medicaid pharmacy reimbursement systems utilize transparent reimbursement methodologies tied to the state's FFS payment methodology, including ingredient cost benchmarks and professional dispensing fees; and

WHEREAS, Transparent reimbursement models tied to Medicaid FFS benchmarks improve accountability, reduce administrative inefficiencies, and ensure that taxpayer funds are directed toward patient care and pharmacy services rather than unnecessary intermediary costs; and

WHEREAS, Illinois has experienced a growing number of pharmacy closures and the emergence of pharmacy deserts, particularly in rural and medically underserved communities, where the loss of local pharmacies can significantly reduce access to medications and pharmacist-provided care services; and

WHEREAS, Pharmacy closures and network instability disproportionately impact Medicaid recipients, who often rely on nearby community pharmacies due to transportation barriers and limited access to other health care providers; and

WHEREAS, Ensuring that pharmacy providers participating in Medicaid managed care are reimbursed at no less than the rate paid under the Medicaid FFS program, including the same professional dispensing fee, can strengthen pharmacy network stability, preserve patient access to medications, and promote continuity of care; and

WHEREAS, Aligning Medicaid managed care pharmacy reimbursement with the state's FFS reimbursement methodology can increase transparency, reduce administrative inefficiencies, and support the long-term sustainability of pharmacy providers serving Medicaid beneficiaries; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE HUNDRED FOURTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we urge the Illinois Department of Healthcare and Family Services (HFS) to ensure that pharmacies participating in Medicaid managed care networks are reimbursed for covered outpatient prescription drugs at a rate no less than the reimbursement that would be paid under the Illinois Medicaid fee-for-service pharmacy program, including both the ingredient cost methodology and the professional dispensing fee; and be it further

RESOLVED, That we urge HFS to implement such reimbursement parity through Medicaid managed care organization contracts and pharmacy benefit manager agreements to ensure consistent, transparent, and fair pharmacy reimbursement across the Medicaid program; and be it further

RESOLVED, That we urge HFS to monitor and report to the General Assembly on the impact of reimbursement parity on pharmacy network participation, patient access to medications, and pharmacy closures within the State; and be it further

RESOLVED, That we encourage HFS to evaluate the effect of reimbursement parity on pharmacy deserts, rural health access, and Medicaid beneficiary access to pharmacist-provided patient care services, including medication counseling, chronic disease management support, HIV PrEP/PEP, contraception assessment, and preventive health services; and be it further

RESOLVED, That a suitable copy of this resolution be delivered to the Director of the Illinois Department of Healthcare and Family Services.