MedicaidPrior AuthHigh impact
Four Prescription Limit
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is implementing a four prescription limit per 30-day period for both adults and children, requiring prior approval for fifth and subsequent prescriptions. The policy has specific exclusions for certain drug classes like antibiotics, oncology drugs, and immunosuppressives.
Action Required
Before implementation (date TBD after July 1, 2012): Billing and clinical staff must prepare workflows for prior authorization requests when patients exceed four prescriptions per 30 days. Set up processes to call 1-800-252-8942 or fax 217-524-7264/217-524-0404 for approval requests. Train pharmacy staff on 72-hour emergency supply procedures for after-hours situations. Review patient medication lists to identify maintenance drugs that could be consolidated to avoid hitting the limit.