Health & Benefits

What prescriptions does Medicaid cover?

Medicaid covers medically necessary prescriptions and some over-the-counter products. Some drugs require prior approval from the Illinois Department of Healthcare and Family Services (HFS). Learn more about Illinois Medicaid prescription coverage on the HFS website. 

What is the four prescription policy?

The Illinois Department of Healthcare and Family Services (HFS) must approve medications after you fill 4 prescriptions in 30 days. This limit applies to adults and children who are Medicaid recipients. 

The following types of drugs do not require prior approval:

• Oncolytics,
• Anti-Retroviral Agents,
• Contraceptives,
• Immunosuppressives,
• Over-the-counter drugs, and 
• Non-drug items such as blood glucose test strips and monitors.

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.

There are several ways to check the status of a request:

• If you are a patient, you may call the Health Benefits Hotline at 1-800-266-0768 or 1-866-675-8440 (TTY).
• If you used the Illinois Rx Portal to enter a prior approval request, you can check the status of the request in that system.

For more information on the four prescription policy, visit the HFS website.