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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/10/06

To: Participating Pharmacies

Date: January 10, 2006

Re: Co-payments for Illinois Cares Rx

 

Generic: $2

 

Brand: $5

 

Non-Preferred: $15

 

Patients enrolled previously enrolled in SeniorCare and Circuit Breaker were subject to a Preferred Drug List established by the Department and enforced through hard prior approval edits at the pharmacy. For those Illinois Cares Rx patients going to Medicare, they must now adhere to the formulary and PDL of their PDP. Prior approvals granted in the past do not carry over to the PDPs. The Department does not cover non-formulary drugs for Medicare enrolled Illinois Cares Rx beneficiaries. In order to give patients more flexibility in their choice of drugs, the department decided to enforce those PDLs with tiered co-pays instead of hard prior approval edits. This allows patients to choose to remain on the non-preferred drug if they are willing to pay the higher co-payment. Patients have the option of switching to a preferred product to get a lower co-payment, or going through the medical exception process with their PDP to remain on the non-preferred product at the lower co-payment.