MedicaidCoverageMedium impact
Chapter P-200, Handbook for Providers of Pharmacy Services Lost, Stolen, or Destroyed Medications and Vacation Supplies of Medications
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Sep 12, 2014
We identified it
Jun 20, 2026
Summary
This Illinois Medicaid policy restricts coverage for lost, stolen, or destroyed medications. Adults can only get replacements for specific exceptions (contraceptives, anticonvulsants, albuterol inhalers, immunosuppressives, insulin vials, antipsychotics), while children through age 20 get one approval per year for any medication except OTC drugs.
Action Required
Immediately: Pharmacy and billing staff must implement new override request procedures for lost/stolen medications. For Medicaid patients, only process replacement requests for adults if medication is on exception list (contraceptives, anticonvulsants for seizures, albuterol for asthma/COPD, immunosuppressives for transplants, insulin vials, antipsychotics for schizophrenia). For children age 20 and under, limit approvals to once per 365-day period. Require police report numbers for stolen medication claims. Controlled substance overrides must come from prescriber, not pharmacy.