Traditional MedicareAdministrativeLow impact
Medicare Part D Copayment Billing for CILA Residents
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jan 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now allows pharmacies to bill copayments to the state for Medicare Part D drugs dispensed to CILA residents who are not enrolled in Home and Community Based Waiver programs. Pharmacies must first bill Medicare Part D, then submit copayment-only claims to Illinois Medicaid using specific NCPDP D.0 claim formatting requirements.
Action Required
For practices with pharmacy services: When dispensing Medicare Part D drugs to CILA residents not in HCBW programs, first bill Medicare Part D to determine copay amount ($1-$6.50), then submit copayment-only claims to Illinois Medicaid using NCPDP D.0 format with Other Coverage Code 308-C8 = 08 and appropriate copayment amounts in fields 478-H7, 479-H8, and 480-H9. Do not include COB/Other Payments Segment.