Illinois Medical Assistance - Supplemental Rebate Offer Form

To request the Illinois Medical Assurance Supplemental Rebate Offer Form to be sent to you to be completed, please submit an e-mail to request Pharmacy Rebate Offer Form or download the Illinois Medical Assistance Supplemental Rebate Offer Form below.

• Rebate Offer Form (xls)

You may register to receive E-mail notification, when a new Preferred Drug List is posted to the Web site, by completing the form for Preferred Drug List E-mail Notification Request.

Inquiries regarding the PDL should be sent via e-mail to Pharmacy.