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Provider Notice issued 11/28/07
Illinois Medicaid Patients on Insulin
| To: | Participating Pharmacies |
| Date: | November 28, 2007 |
| Re: | Illinois Medicaid Patients on Insulin |
The Department has made a change to the PDL for insulin. Novolog and Novolin products are now HFS's preferred short-acting insulin products. Levemir is now the preferred long-acting insulin.
In order to ease the transition to the preferred products, we will not implement the prior approval requirement for Humalog and Humulin products until December 17, 2007. Further, existing Lantus patients will be grandfathered on Lantus until January 7, 2008 in order to allow patients time to switch to the preferred product.
When Medicaid patients present to fill their non-preferred insulin prescriptions over the next several weeks, please contact their doctor to request they be switched to a preferred product when clinically appropriate.
If the patient’s physician decides that there is a medical reason that a patient must continue to use an insulin product that is not preferred, prior approval must be requested. Prior approval may be requested by calling 1-800-252-8942, or by fax at 217-524-0404 or 217-524-7264. Prior approval forms may be found at http://www.hfs.illinois.gov/pharmacy/prior.html.
The Department appreciates the assistance of pharmacies in this effort. Your help in ensuring that, when possible, patients are proactively switched to preferred products before the transition period expires will make this transition easier for patients and their providers.
Please remember that in an emergency, pharmacies can dispense and be reimbursed for a 72-hour supply of medication. Because insulin cannot be dispensed as a 72-hour supply, this policy will allow pharmacies to dispense a full vial of insulin in an emergency and be reimbursed.