MedicaidCoverageMedium impact
Billing Guidance -- Oral Antivirals for the Treatment of COVID-19
Illinois Medicaid - HFS·IL · Pharmacy, Infectious Disease·Provider Notice
Effective date
Dec 23, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers federally allocated oral COVID-19 antivirals (Paxlovid and Molnupiravir) with specific billing requirements. Pharmacies can bill retroactively to December 23, 2021, using specific NCPDP claim submission procedures with $0.00 ingredient cost and dispensing fee reimbursement.
Action Required
Immediately: Pharmacies billing Illinois Medicaid must update NCPDP claim submission procedures for COVID-19 oral antivirals. Submit claims with Basis of Cost Determination code '15', Ingredient Cost of $0.00, and Days Supply of '5'. Use approved NDCs for Paxlovid and Molnupiravir. Can bill retroactively to December 23, 2021. Contact pharmacy billing consultant at 877-782-5565 for questions.