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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/18/2024

 

To: Enrolled Pharmacies
​Date October 18, 2024
​Re:
 Over-the-Counter Birth Control Update

This notice is a follow-up to the December 18, 2023, provider notice announcing coverage for the over-the-counter birth control pill, Opill. It became available with an effective date of March 5, 2024, except for NDC 00113810104, which has an effective date of March 26, 2024. Opill is covered by HFS under both the fee-for-service (FFS) program and managed care organizations (MCOs).

Due to the Change Healthcare system outage experienced by the Department of Healthcare and Family Services (HFS) as noted in the February 22, 2024, provider notice, providers were previously unable to bill for this product. As part of the restoration of our systems, the drug file has been successfully loaded and pharmacies may now bill for this product back to the effective date for each NDC.

HFS requires pharmacies to submit all claims, including those for OTC medications, with a prescriber National Provider Identifier (NPI) in the Prescriber ID field (411-DB). For Opill, pharmacies may bill using the Illinois Department of Public Health (IDPH) standing order for hormonal contraceptives. As a reminder, hormonal contraceptives can be billed for up to a 100-day supply.

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