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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/10/2025

 

To:
 Enrolled Hospitals, Pharmacies, Physicians, Nurses, and other Governmental Payors
​Date October 10, 2025
​Re:
 Prior Authorization- Hemophilia Drugs

This notice informs providers of the Department of Healthcare and Family Services’ (HFS) compliance with Public Act 103-0659 which amends the Prior Authorization Reform Act. The Act provides that a health insurance issuer or a contracted utilization review organization may not require a prior authorization for drug therapies approved by the U.S. FDA for the treatment of hereditary bleeding disorders any more frequently than 6 months or the length of time the prescription for that dosage remains valid, whichever period is shorter.

The policy applies to both the fee-for-service (FFS) program and managed care organizations (MCOs), effective January 1, 2026.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.

 

Laura Phelan
Division of Medical Programs