MedicaidPrior AuthMedium impact
Chapter P-200, Handbook for Providers of Pharmacy Services Four Prescription Policy Exception - Antipsychotics
Illinois Medicaid - HFS·IL · Psychiatry, Pharmacy·Provider Notice
Effective date
Jul 1, 2014
We identified it
Jun 20, 2026
Summary
Antipsychotic drugs are now exempt from the Four Prescription Policy prior authorization requirement, even when patients have already filled four or more prescriptions in the preceding 30 days. Pharmacies should no longer request Four Prescription Policy overrides for antipsychotic medications.
Action Required
Immediately: Update billing and pharmacy systems to remove prior authorization requirements for antipsychotic drugs under the Four Prescription Policy. Train staff to stop requesting Four Prescription Policy overrides for antipsychotic medications. Review current antipsychotic prescriptions to ensure no unnecessary prior auth delays.