Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, requires the department to develop a program of hemophilia utilization review and control which may include a requirement for prior approval prior to reimbursing providers for blood factor.
The department requires that providers who dispense blood factor meet special standards. Those standards include assay management; maintenance of stock; emergency dispensing timeframes; data collection; cold chain management and packaging practices; and product recall protocols.
The department also requires pharmacies to sign a Standards of Care Agreement (SOCA) and obtain prior approval in order to be reimbursed for blood factor dispensed to HFS clients. The SOCA mandates that certain quality of care measures be met by the dispensing pharmacy to ensure quality care for HFS clients, while ensuring that only the appropriate amount of factor is dispensed.
The department will monitor providers to ensure appropriate clinical services are being provided through retrospective reviews and client surveys. Failure to meet one or more of the standards set forth in the agreement will lead to suspension of the provider's ability to dispense blood factor to HFS clients until such standard(s) are met.
Providers wishing to dispense blood factor to Illinois Medicaid participants that have not already returned a signed copy of the SOCA to the department should return two signed copies to the Department at the address listed below.
Illinois Department of Healthcare & Family Services
Bureau of Pharmacy Services
607 East Adams Street, 4th Floor
Springfield, IL 62701
The SOCA can be found at the link below.
Questions or comments regarding the department’s Hemophilia Care Management Program can be directed to the department at HFS.HemoCareManagmnt@illinois.gov.