MedicaidAdministrativeMedium impact
Safety Edits During Pharmacy Benefit Management System (PBMS) Outage
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Feb 23, 2024
We identified it
Jun 20, 2026
Summary
Due to a Pharmacy Benefit Management System (PBMS) outage, Illinois Medicaid is requesting that pharmacies implement enhanced safety reviews for prescription claims since the state cannot perform its normal claim editing and review functions. Pharmacies should pay special attention to drug interactions, duplicate therapy, dosage appropriateness, and limit dispensing to 30-day supplies during the outage period.
Action Required
Immediately: If your practice has an in-house pharmacy or works closely with pharmacies, inform them to implement enhanced safety reviews during the PBMS outage. Monitor Optum/Change Healthcare webpage for ongoing status updates. Contact pharmacy consultant at 877-782-5565 for FFS claims questions or appropriate MCO for managed care questions.