Prior approval means that your doctor(s) must complete forms stating the reason why your prescription(s) are “medically necessary” and submit them to HFS (or to your HMO, if you are participating in the Integrated Care Program) and get permission for your prescription(s).
The first step to securing prior approval is to let all of your doctors, medical providers and pharmacists know about this change in coverage.
Make sure that you have all needed prescriptions refilled in June.
Check the refill dates now and get ready to request refills on the correct date.
Let your providers know right away if you are concerned about running out of medications and/or supplies.
We are waiting to get more information from HFS regarding how the new prior approval system will work.
We do not yet know if you will need to request new prior approvals each month.
The Arc of Illinois will send out additional consumer education alerts when information is available.
The pharmacy is not allowed to fill your prescription and bill Medicaid (or your HMO) until the prior approval process is complete. Your “options” are to wait for the prior approval process OR to pay for the prescription yourself if you are able to do so. This is called “self-pay”. How can I get more information about this new regulation?
Medicaid enrollees, parents, guardians, case managers and service provider agencies can contact the Pharmacy Unit at (217) 782-5565 option 7, or visit the Medicaid Pharmacy Unit website: http://www.hfs.illinois.gov/pharmacy/.
Medical providers can call the HFS Drug Prior Approval hotline1-800-252-8942.
Medicaid enrollees participating in the Integrated Care Program should contact their managed care company representative:
Families and individuals enrolled in Illinois Health Connect, the Primary Care Case Management Program, or other Medicaid HMOs (not part of the Integrated Care Program) can get contact information at http://www.illinoishealthconnect.com/clients/importantphonenumbers.aspxor by callingthe Illinois Health Connect Helpline at 1-877-912-1999 or TTY: 1-866-565-8577.