Pharmacy

Medicaid patients can and should have access to medications that are medically necessary. This section has approved drug lists and other regulations.

The Illinois Medicaid program covers prescription drugs, as well as some over-the-counter (OTC) products, made by manufacturers that have a signed rebate agreement with the federal Centers for Medicare and Medicaid Services (CMS). Some prescription drugs and OTC products require prior approval from HFS before reimbursement. 

• Uniform Prior Authorization Workgroup Agenda for 03/18/2022 (pdf)
  
• Uniform Prior Authorization Workgroup Agenda for 03/04/2022 (pdf)
  
• Four Prescription Policy

• Pharmaceutical Labelers With Signed Rebate Agreements (Alpha and Numeric complete lists)

• ILLINOIS Rx Portal
• Drug Utilization Review
  
• 340B Purchased Drugs FAQs
• Four Prescription Policy
• Search for Prior Approval Status by Drug
• Hemophilia Care Management Program
• Tamper-Resistant Rx Pads
• Long Term Care Pharmacy Information

• Medicaid Preferred Drug List
• Preferred Drug List E-Mail Notification Request

• Class Review Schedule
• Drugs and Therapeutics Advisory Board
• Drugs and Therapeutics Advisory Board Meeting Minutes
• Instructions for Submission of Clinical Information
• Manufacturer Contact Form
• Medical Assistance - Supplemental Rebate Offer Form
• Preferred Drug List Background
• Preferred Drug List Process
• Public Speaking Guidelines
• Public Testimony Registration and Conflict of Interest Disclosure Form

• Criteria and Forms
• Drug Prior Approval Information
  
• Pharmacy Prior Authorization Request HFS 1409X (pdf)
  

• FAQS - Medical Electronic Data Interchange (MEDI) System
• FAQS- MEDI facts for Providers (pdf)

• State MAC Web site
• Federal Upper Limits for Drugs
• Pharmacy Provider Releases