MedicaidPrior AuthMedium impact
Exondys 51 and Spinraza Prior Authorization Criteria Update
Illinois Medicaid - HFS·IL · Neurology, Pediatrics·Provider Notice
Effective date
Dec 20, 2018
We identified it
Jun 20, 2026
Summary
Illinois Medicaid (HFS) has immediately updated prior authorization criteria for Exondys 51 and Spinraza medications. Both drugs now require submission of prior authorization requests using the regular prior authorization form found on the HFS Drug Prior Approval Criteria and Forms webpage.
Action Required
Immediately: Billing team must review updated Exondys 51 and Spinraza prior authorization criteria on the HFS Drug Prior Approval Criteria and Forms webpage. Update workflow to use the regular prior authorization form for both medications instead of any previously used forms. Ensure all future Exondys 51 and Spinraza requests follow the new criteria to avoid claim denials.