MedicaidCoverageHigh impact
Changes in Policy for Injectable Drugs
Illinois Medicaid - HFS·IL · Rheumatology, Gastroenterology, Dermatology +3 more·Provider Notice
Effective date
Jul 15, 2005
We identified it
Jun 21, 2026
Summary
Effective July 15, 2005, physicians can no longer bill directly for six injectable drugs (Enbrel, Humira, Remicade, Risperdal Consta, Synagis, and Xolair) - only enrolled pharmacies can submit claims for these medications. Physicians can still bill for drug administration using procedure code 99211, and all six drugs now require prior authorization.
Action Required
By July 15, 2005: Billing team must stop submitting drug claims for Enbrel, Humira, Remicade, Risperdal Consta, Synagis, and Xolair - coordinate with enrolled pharmacies for drug billing instead. Update billing system to use CPT 99211 for administration of these drugs. Implement prior authorization requirements for all six drugs using forms from dpaillinois.com/pharmacy/, submitting requests via fax to 217-524-7264 or 217-524-0404. Note special Synagis coverage limited to October 1 - April 30 annually.