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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/07/11

To:​​  Participating Pharmacies                                                                                                  

​Date:​  July 7, 2011

​Re:​  Changes to the Illinois Rx Program

 

As a result of budget reductions, effective September 1, 2011, the income limits have been lowered for Illinois Cares Rx. As a result, some current members will lose coverage effective September 1, 2011. If a beneficiary has Medicare, his or her copayments will be those established by their Medicare Part D plan.

In addition, effective September 1, 2011, copayments and cost-sharing will increase for members who continue to be eligible for Illinois Cares Rx. The new copayment amounts are listed below.

For Medicare beneficiaries, each 30-day supply:

 

  • $5 for generic drugs;
  • $15 for preferred brand name drugs;
  • $20 for non-preferred brand name drugs; and
  • $15 for specialty drugs.

After the total cost of a beneficiary's drugs reaches $2,840, 25% of the cost of each prescription, plus the appropriate co-payment.

 

For non-Medicare beneficiaries or for Medicare-excluded drugs billed to the department:

  • $5 for generic drugs;
  • $15 for preferred brand name drugs; and
  • 25% of the cost of each prescription, plus co-payment ($5 or $15), after Illinois Cares Rx pays $1,750 in benefits.

If you have questions, please contact the Bureau of Pharmacy Services at 877-782-5565, option 7.

 

Theresa A. Eagleson, Administrator
Division of Medical Programs