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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/15/13

Clotting Factor Dispensing April 1, 2013

To:​ Participating Pharmacies ​
Date:​ March 15, 2013​
Re:​ Clotting Factor Dispensing April 1, 2013 ​

As a result of Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, the department developed a program of utilization management and control for patients with hemophilia who fill blood factor prescriptions. This included requiring providers who dispense blood factor to sign a Standards of Care Agreement (SOCA) with the department in order to be allowed to dispense blood factor to our clients. 

The SOCA has been revised to address concerns raised by the provider community, and to address issues the department has experienced since implementation of the initial SOCA. The new SOCA, which is available on the department’s Web site, must be signed and on file with the department by April 1, 2013. For dates of service on or after April 1, 2013, providers must have a new SOCA on file with the department in order to be reimbursed for blood factor. Claims from providers who do not have a new SOCA on file will reject with the following rejection message:  Standards of Care Agreement not on File. 

Providers should mail the signed SOCA to the following address:

Illinois Department of Healthcare and Family Services

Bureau of Pharmacy Services

607 East Adams Street, 4th Floor

Springfield, Illinois  62701

 

Any questions regarding this notice should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs