Illinois

The Department of Healthcare and Family Services (HFS) has issued a Provider Notice regarding Respiratory Syncytial Virus (RSV) vaccines for Medicaid customers. Additional information on other Provider Notices regarding these vaccines are available online.  

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for Medicaid Fee-for-Service claims, or the appropriate Medicaid Managed Care program. 

Also in Illinois, the Department of Healthcare and Family Services (HFS) continues to prepare for the release of the new over-the-counter (OTC) birth control pill, Opill, which is anticipated in early 2024. Opill will be covered by HFS under both the Medicaid Fee-for-Service (FFS) and Managed Care programs without a prescription for women aged 18 years and older. 

HFS requires pharmacies to submit all claims, including those for OTC medications, with a prescriber National Provider Identifier (NPI) in the Prescriber ID field (411-DB). For Opill, pharmacies may bill using the Department of Public Health standing order prescriber NPI for hormonal contraceptives.    

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate Medicaid Managed Care program. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.