Agencies
Services
Provider Notice Issued 04/22/2025
- Non-preferred medications
- Preferred medications requiring prior authorization, as listed on the Preferred Drug List (PDL)
- Practitioner-administered drugs designated with an ‘N’ on the Practitioner Fee Schedule
| To: | Enrolled Pharmacies; Hospitals; Federally Qualified Health Centers; Encounter Rate Clinics; Rural Health Clinics; Physicians; Physician Assistants; and Advanced Practice Registered Nurses |
| Date | April 22, 2025 |
| Re: |
Resuming Pharmacy Prior Authorization System April 29, 2025 |
The Department of Healthcare and Family Services’ (HFS) fee-for-service (FFS) prior authorization system for prescription drugs has been offline since the Change Healthcare system outage on February 21, 2024. However, normal operations will resume on April 29, 2025.
Starting at 8:00 AM on Tuesday, April 29, 2025, HFS will reinstate standard prior authorization requirements for:
To ensure continuity of care, patients who have been receiving medications that typically require prior authorization, but were approved during the outage, may qualify for a 90-day transition period. This allows time for patients to consult with their providers and shift to appropriate medications as needed.
Any prior authorization requests submitted between February 21, 2024, and April 28, 2025, will need to be resubmitted, if the patient continues to have a need for that medication.
For prior authorizations previously approved with expiration dates that came due during the system outage, extensions will be granted as follows:
If PA expired in: |
Due date extended to: |
February, March, April 2024 |
July 15, 2025 |
May, June, July 2024 |
August 15, 2025 |
August, Sept, October 2024 |
September 15, 2025 |
November, December 2024 |
October 15, 2025 |
January, February 2025 |
November 1, 2025 |
Non-covered drugs will be denied.
Prescribers or pharmacies may submit prior authorization requests by phone to 800-252-8942 or 877-782-5565, or by fax to 217-524-7264.
Questions regarding this notice may be directed to a pharmacy billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medicaid Programs