Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 06/02/05

To: Participating Physicians, Pharmacies, Advanced Practice Nurses and Local Health Departments

Date: June 2, 2005

Re: Changes in Policy for Injectable Drugs

 

Effective July 15, 2005, the department will no longer reimburse physicians for Enbrel, Humira, Remicade, Risperdal Consta, Synagis and Xolair. Only enrolled pharmacies will be allowed to submit claims for these drugs. The department will continue to reimburse physicians for the administration of the drugs. Physicians should bill procedure code 99211 when seeking reimbursement for the administration.

 

The above-named drugs will require prior authorization for dates of service on or after July 15, 2005. Special prior approval requirements for Synagis are outlined below. Prior authorization forms and criteria may be found on the department’s Web site at: http://www.dpaillinois.com/pharmacy/ . Prior authorization requests may be submitted by fax only to 217-524-7264 or 217-524-0404. Coverage of prescription drugs is limited to products from companies that have signed rebate agreements with the Centers for Medicare & Medicaid Services (CMS).

 

Special Billing and Prior Approval Requirements for Synagis

 

Effective immediately, coverage of Synagis will be limited to the following dates of service, October 1 through April 30, each year. Administration of Synagis, during the period of May 1 through September 30, is considered off-season and not medically necessary.

 

Please remember, providers wishing to receive e-mail notification, when new provider information has been posted by the department, may register at the following IDPA Web site:

 

http://www.dpaillinois.com/provrel/

 

The department also offers e-mail notification when a new preferred drug list has been posted. You may register at the following IDPA Web site:

 

 

http://www.dpaillinois.com/pdl/pdlform.html

 

Questions regarding this notice may be directed to the Bureau of Pharmacy Services at 1-877-782-5565.

 

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs