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Illinois Medicaid - HFSMedicaid · Coverage · Provider Notice · IL · PharmacyMedium impact

2027 Critical Access Pharmacy (CAP) Program

Act
by Oct 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 26, 2026

Summary

Illinois Department of Healthcare and Family Services (HFS) is establishing a 2027 Critical Access Pharmacy (CAP) Program that provides enhanced dispensing fee payments to eligible independent pharmacies. Pharmacies must meet specific ownership, location, and prescription volume criteria and complete online attestation between October 1-31, 2026, to qualify for Calendar Year 2027 benefits.

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What to do

by Oct 31, 2026 · 4 steps
01If your practice operates or refers to an independent pharmacy in Illinois, verify whether the pharmacy meets CAP eligibility criteria (fewer than 10 pharmacy locations, brick-and-mortar Illinois location, at least 51% non-mail-order prescriptions, and location in county under 50,000 population or MUA-designated area).
02Coordinate with eligible pharmacies to ensure they complete the online attestation form by the October 31, 2026 deadline to avoid disqualification.
03By December 10, 2026: If a pharmacy's eligibility is denied, submit appeals with supporting documentation to HFS.CriticalAccessPharmacy@illinois.gov.
04Verify the final eligibility list posted on HFS website by December 1, 2026, to confirm which pharmacies will receive enhanced dispensing fees starting January 1, 2027.
If missed: Failure to complete attestation by October 31 will disqualify pharmacies from 2027 CAP program benefits.

Original notice

2027 Critical Access Pharmacy (CAP) Program
hfs.illinois.gov · Always check the source before changing claims.
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Related changes

See all Illinois Medicaid - HFS changes →
Critical Access Pharmacies’ (CAP) Self-Attest CriteriaLowEffective Jul 1, 2018 · Provider NoticeCritical Access Pharmacies (CAP) Attestation Period ClosureHighEffective Apr 19, 2019 · Provider NoticeCritical Access Pharmacy (CAP) Dispensing Fee ProgramLowEffective Jul 1, 2020 · Provider NoticeCritical Access Pharmacy (CAP) UpdateMediumEffective Jan 1, 2026 · Provider NoticeBrowse every Illinois Medicaid - HFS change in the policy list

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Illinois Medicaid - HFS policiesIL policy changesPharmacy

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