MedicaidPrior AuthMedium impact
Prior Approval for Antipsychotic Medications for Long Term Care (LTC) Residents
Illinois Medicaid - HFS·IL · Psychiatry, Geriatrics, Family Medicine +1 more·Provider Notice
Effective date
Jun 1, 2011
We identified it
Jun 21, 2026
Summary
Illinois Medicaid now requires prior authorization for all antipsychotic medications dispensed to long-term care (LTC) residents, with existing patients with serious mental illness grandfathered. Emergency 72-hour supplies are allowed during non-business hours with subsequent prior authorization required.
Action Required
Before June 1, 2011: For LTC residents requiring antipsychotic medications, providers must submit prior authorization using Form HFS 168 through Illinois HFS. Medical directors should review current patient medication regimens and facilitate prior approval requests. Pharmacies must submit prior approval requests for any emergency 72-hour supplies dispensed during non-business hours. Contact Bureau of Pharmacy Services at 1-877-782-5565, Option 7 for questions.