MedicaidCoverageLow impact
Over-the-Counter Birth Control Update
Illinois Medicaid - HFS·IL · Pharmacy, OB-GYN, Family Medicine·Provider Notice
Effective date
Mar 5, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now allows pharmacies to bill for over-the-counter birth control pill Opill back to its March 2024 effective date, following resolution of the Change Healthcare system outage. Pharmacies can use Illinois Department of Public Health standing orders and bill for up to 100-day supplies.
Action Required
Immediately: Pharmacies should begin billing Illinois Medicaid for Opill using NDC codes with IDPH standing order NPI in the Prescriber ID field (411-DB). Claims can be submitted retroactively to March 5, 2024 (or March 26, 2024 for NDC 00113810104). Non-pharmacy providers should be aware this OTC contraceptive is now billable under Medicaid.