MedicaidPrior AuthLow impact
Duration of Therapy Edit
Illinois Medicaid - HFS·IL · Family Medicine, Internal Medicine, General Practice +1 more·Provider Notice
Effective date
Mar 2, 2009
We identified it
Jun 21, 2026
Summary
Effective March 2, 2009, Illinois Medicaid implemented a Duration of Therapy edit limiting nicotine replacement patches to 90 days within a 365-day period. Claims exceeding this limit will be rejected unless a Refill-Too-Soon override is requested by the pharmacy with prescriber justification.
Action Required
No immediate action required - this is a historical 2009 policy. If currently prescribing nicotine replacement patches for Illinois Medicaid patients, ensure pharmacy is aware that therapy beyond 90 days requires prior authorization using the Refill-Too-Soon Prior Approval Request Worksheet.