The Illinois Department of Healthcare and Family Services (HFS) updated its Four Prescription Policy, effective April 1, to reduce the number of prescriptions a client can fill in a 30-day period, without prior authorization, from five to four.
Currently, this policy does not affect children less than 19 years old. This policy requires providers to request prior approval for clients who need to fill more than four prescriptions in a 30-day period.
Certain drugs do not need prior approval. The exempt classes of drugs are: oncolytics, anti-retroviral agents, contraceptives, over-the-counter drugs, and non-drug items such as blood glucose monitors and test strips.
Prior approval can be requested via an application on the HFS MEDI System, an online form or a faxed form. Send faxes to 217-524-7264.
It is also possible to make prior approval request by calling 1-800-252-8942.
Do not call to check on the status of a PA request. Status can be checked via MEDI or this online inquiry form.
During non-business hours, when HFS staff is not able to make determination on a PA request, pharmacies may issue and HFS will pay for a 72-hour supply of a covered drug for an eligible client in an emergency situation. The pharmacy is responsible for following up with a PA request for the emergency supply.
