MedicaidPrior AuthHigh impact
Prior Approval Requirements for Clotting Factor
Illinois Medicaid - HFS·IL · Hematology, Pharmacy·Provider Notice
Effective date
Dec 10, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior approval for all blood clotting factor dispensing beginning December 10, 2012. Pharmacies must obtain approval for each dispensing and ensure patients have no more than a 7-day supply on hand.
Action Required
By December 10, 2012: Billing team must implement prior authorization requirements for all blood clotting factor dispensing for Illinois Medicaid patients. Pharmacies must request approval within 2 hours for each dispensing, verify patients have no more than 7-day supply on hand, and submit new prior approval requests for any prescription changes including brand, dose, or schedule changes. Sign revised Standards of Care Agreement when received. Contact Bureau of Pharmacy Services at 1-877-782-5565 option 7 for questions.