MedicaidPrior AuthMedium impact
Stage 4 Cancer Medications
Illinois Medicaid - HFS·IL · Oncology, Hematology·Provider Notice
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
Starting January 1, 2019, Illinois Medicaid and other health insurers cannot require step therapy (trying other drugs first) for FDA-approved stage 4 metastatic cancer medications. Coverage must be provided as long as the drug use follows NCCN guidelines and is supported by peer-reviewed medical literature.
Action Required
By January 1, 2019: Billing teams should update prior authorization processes to align with Public Act 100-1057. Remove step therapy requirements for stage 4 metastatic cancer drug authorizations when treatment follows NCCN guidelines. Ensure documentation shows treatment is consistent with best practices and supported by peer-reviewed literature.