MedicaidReimbursementMedium impact
Pharmacy Reimbursement Methodology
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jul 15, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has implemented new pharmacy reimbursement methodology using Actual Acquisition Cost (AAC) and National Average Drug Acquisition Cost (NADAC) for fee-for-service claims. Professional dispensing fees are now $8.85 for non-critical access pharmacies and $15.55 for critical access pharmacies, with system updates for CAP fees still pending.
Action Required
Immediately: Pharmacy billing staff must update reimbursement expectations for Illinois Medicaid fee-for-service claims to reflect new AAC-based methodology. Critical Access Pharmacies should prepare to void and rebill claims processed between July 15, 2019 and CAP system implementation date to receive correct $15.55 dispensing fee instead of interim $8.85 fee. Contact Bureau of Professional and Ancillary Services at 877-782-5565 with questions.