MedicaidPrior AuthMedium impact
Four Prescription Policy
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 26, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior authorization for prescriptions after a patient fills 4 medications in 30 days under the SMART Act. The policy is being phased in, currently requiring prior auth after 9 prescriptions, with exclusions for oncology, antiretroviral, contraceptive, and immunosuppressive drugs.
Action Required
Immediately: Billing team must implement prior authorization workflow for Illinois Medicaid patients with more than 4 prescriptions per 30 days. Register for MEDI online system for streamlined PA requests. Update patient alerts in system to flag high prescription volume. Train staff on 72-hour emergency supply protocol and PA request methods (phone, fax, online). Claims will be rejected without proper prior authorization.