Pharmacy – Resumption of Billing Policies at COVID-19 Public Health Emergency End

By May 12, 2023: Billing team must update pharmacy billing procedures for Illinois Medicaid fee-for-service patients. Remove emergency override codes (420-DK 13) from refill too soon claims. Implement quantity limits: blood glucose strips and lancets to 200 per month maximum. Reinstate prior authorization requirements for brand name drugs (3 brand limit) and multiple prescriptions (4 prescription limit). Update billing system to require prior auth when primary insurance rejects due to deductibles. Contact individual MCOs for their specific implementation timelines as they may differ from FFS requirements.