Illinois HR 746: MEMORIAL-ALLEN F. BENNETT

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HR0746LRB104 21206 RMO 35716 r

1HOUSE RESOLUTION

2 WHEREAS, The Medicaid program administered by the Illinois 

3Department of Healthcare and Family Services (HFS) provides 

4health coverage to more than three million Illinois residents, 

5including low-income families, seniors, individuals with 

6disabilities, and children; and

7 WHEREAS, Community pharmacies serve as one of the most 

8accessible health care providers for Medicaid recipients, 

9ensuring access to life-saving medications, medication therapy 

10management, clinical consultation, and pharmacist-provided 

11patient care services; and

12 WHEREAS, The Medicaid fee-for-service (FFS) pharmacy 

13reimbursement methodology is designed to reimburse pharmacies 

14using transparent ingredient cost benchmarks along with a 

15professional dispensing fee, which reflects the cost of safely 

16dispensing medications, including pharmacist review, drug 

17utilization review, compliance with federal and state 

18regulatory requirements, patient counseling, and maintaining 

19pharmacy operations; and

20 WHEREAS, Under the Medicaid managed care system, pharmacy 

21reimbursement is frequently determined through contracts 

22between managed care organizations (MCOs) and pharmacy benefit 

HR0746- 2 -LRB104 21206 RMO 35716 r

1managers (PBMs), which may reimburse pharmacies at rates that 

2differ from the Medicaid FFS methodology, creating payment 

3instability and uncertainty for pharmacy providers; and

4 WHEREAS, Reimbursement below the Medicaid FFS benchmark 

5can create financial pressure on pharmacies serving Medicaid 

6beneficiaries, particularly independent pharmacies and 

7pharmacies located in rural and underserved communities; and

8 WHEREAS, Numerous st