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Illinois lawmakers to consider fee schedule changes, formulary

Posted On: Jan. 31, 2023 10:12 AM CST

drug formulary

The Illinois Workers’ Compensation Commission would be required to establish a new medical fee schedule and implement a closed drug formulary, under legislation introduced Monday.

H.B. 1548 would render all current medical fee schedules inoperative after Aug. 31, 2024, and establish new reimbursement rates based on Medicare percentages. The bill would also require annual updates to the fee schedule starting Sept. 1, 2025, that would be equal to exactly half the increase in the Consumer Price Index.

H.B. 1546 would require the commission to adopt an evidence-based drug formulary by Sept. 1. The bill does not direct the commission toward any current formulary.

Also drug-related, H.B. 1544 would establish payment conditions for compound drugs, stating that such prescriptions for more than a one-time, seven-day supply would be payable only if there are no readily available commercial products and the active ingredients each have a National Drug Code number and are components of drugs already approved by the U.S. Food and Drug Administration.

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