MedicaidAdministrativeLow impact
Prescription Opioid Antagonists
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jun 14, 2016
We identified it
Jun 20, 2026
Summary
Illinois pharmacists must complete DHS-approved training before dispensing opioid antagonists to Medicaid participants without prior authorization. Pharmacies must maintain CPE Monitor certificates and provide them to the Department upon request or face audit findings and recoupment.
Action Required
No direct billing team action required - this policy affects pharmacies dispensing opioid antagonists to Medicaid participants. Billing teams should be aware that opioid antagonist claims may be subject to audit if dispensing pharmacists lack required certification.