MedicaidReimbursementLow impact
Critical Access Pharmacy (CAP) Program Professional Dispensing Fee
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jul 15, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid increased the professional dispensing fee to $15.55 for Critical Access Pharmacies (CAPs) effective July 15, 2019. Eligible pharmacies must attest to meeting CAP criteria within 30 days and rebill claims from July 15-September 12, 2019 to receive the higher dispensing fee.
Action Required
By January 16, 2020: Critical Access Pharmacies must attest to meeting State Plan CAP criteria to receive $15.55 dispensing fee. Eligible pharmacies must void and rebill all claims processed between July 15, 2019 and September 12, 2019 to receive corrected professional dispensing fee. Contact pharmacy billing consultant at 877-782-5565 for rejections or questions.