The Illinois Department of Healthcare and Family Services (HFS) must approve medications after you fill 4 prescriptions in 30 days. This 4 prescription limit applies to both adults and children. This typically only applies to Medicaid recipients who are not enrolled in a Medicaid managed care plan.
The following types of drugs do not require prior approval:
- Anti-Retroviral Agents
- Over-the-counter drugs
- Non-drug items such as blood glucose test strips and monitors
Approvals are for one year. In certain circumstances, short-term approval will be granted. When HFS is not available to process requests, a pharmacy can give out a 72-hour emergency supply.
The following methods may be used to check the status of a request:
- Telephone - If you are a patient you may call the Health Benefits Hotline for information at 1-800-266-0768 or 1-877-204-1012 (TTY).
- MEDI - If you use the Medical Electronic Data Interchange (MEDI) system to enter a prior approval request, you can check the status of the request through the MEDI system using the prior approval request number.
For more information on the four prescription policy, visit the HFS website.