MedicaidCoverageMedium impact
Managed Care Organization Grandfathering Clause for Certain Drugs
Illinois Medicaid - HFS·IL · Psychiatry, Endocrinology, Cardiology +5 more·Provider Notice
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid MCOs are adopting the state's Preferred Drug List effective January 1, 2020, but patients currently stable on medications that are becoming non-preferred will be grandfathered for one year. This affects a wide range of drug classes including ADHD medications, antidepressants, diabetes drugs, and many specialty medications.
Action Required
Immediately: Contact each Illinois Medicaid MCO to understand their specific grandfathering implementation strategy for patients on non-preferred medications. Update prior authorization workflows to account for grandfathered patients who may not need PA for previously covered drugs. Review patient medication lists in the affected drug classes to identify those who may benefit from grandfathering protection.