MedicaidPrior AuthMedium impact
Four Prescription Limit – Update and Clarification
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Sep 4, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is enforcing a four prescription limit per month for patients, starting with those exceeding 10 prescriptions. When pharmacies bill prescriptions that exceed this limit, claims will reject unless prior approval is obtained, with specific exemptions for certain drug classes.
Action Required
Immediately: Billing team must coordinate with providers to identify patients approaching the four prescription limit. Providers should use the Medical Electronic Data Interchange (MEDI) system, call 1-800-252-8942, or fax to 217-524-7264/217-524-0404 to request prior approval for prescriptions beyond the limit when medically necessary. Update workflow to monitor prescription counts and prepare for claim rejections with error message 'Exceeds HFS Maximum Scripts Per 30 Day.'