MedicaidPrior AuthHigh impact
Prior Approval for Certain Drugs
Illinois Medicaid - HFS·IL · Oncology, Infectious Disease, Gastroenterology +4 more·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior authorization for brand-name immunosuppressive drugs, hepatitis C treatments, erythropoietin products, HIV/AIDS medications, and oncology drugs effective July 1, 2012. Generic immunosuppressive agents remain available without prior approval, and current patients have grandfathering provisions ranging from 60 days to long-term.
Action Required
By July 1, 2012: Billing team must obtain prior authorization before prescribing or dispensing the listed brand-name drugs through pharmacy billing. Update billing system to flag these medications: Cellcept, Imuran, Neoral, Prograf, Sandimmune (immunosuppressive); Ribavirin, Incivek, Peg-Intron, Pegasys, Victrelis (Hepatitis C); Aranesp, Procrit, Epogen, Omontys (erythropoietin); Fuzeon, Selzentry (HIV/AIDS); and specified oncology drugs. Contact Bureau of Pharmacy Services at 1-877-782-5565 option 7 for questions. Claims will be denied without proper prior authorization.