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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/23/2024

 

To:
 Enrolled Pharmacies
​Date: ​February 23, 2024
​Re: Safety Edits During Pharmacy Benefit Management System (PBMS) Outage

The Department of Healthcare and Family Services (HFS) is experiencing a system outage as noted in the Provider Notice dated February 22, 2024. At this time, HFS does not have the ability to edit or review pharmacy claims.

With the knowledge that pharmacies have their own system safety edits, HFS is requesting that pharmacies pay special attention and review patient information, watch closely for drug-to-drug interactions, duplicate therapy, appropriate dosage, or any adverse effects that could affect this vulnerable population during the time that HFS does not have the ability to review or edit pharmacy claims.

As a reminder, in an effort to keep our population healthy and safe, we request that pharmacies, in good faith, continue to fill prescriptions at the prescribed quantity, not to exceed a 30-day supply, to eligible customers. This authority is granted by 89 Ill. Admin. Code 140.442, which states that HFS can provide for the dispensing of at least a 72-hour supply of a covered prescription drug in an emergency situation.

Ongoing status updates on the PBMS outage are available on the Optum/Change Healthcare webpage. A copy of a fax blast and an outage FAQ document from Optum/Change Healthcare are linked from this notice.

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate MCO.

 

 

Kelly Cunningham, Administrator
Division of Medical Programs