The Department of Healthcare and Family Services (HFS) is providing this update regarding buprenorphine dosing for pregnant individuals with a substance use disorder (SUD) diagnosis, who, due to growing fetus and maternal weight gain, are likely to require a higher dosage than the usual 24 mg maximum dose.
HFS is working on programming to allow a total daily dose of up to 32 mg of all buprenorphine products (monotherapy as well as combination products with naloxone) for pregnant individuals with SUD without a prior authorization, when both diagnoses (pregnancy and SUD) are noted on the prescription.
These services will be covered under both the fee-for-service (FFS) program and managed care organizations (MCOs) with a target implementation date of February 1, 2024.
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 MCO plan.
Also in Illinois, Public Act 103-1425, which became effective January 1, 2024, requires prescriptions to be issued electronically unless one or more of a variety of exemptions are met.
Illinois Retail Merchants Association (IRMA) and the Illinois Pharmacists Association (IPhA) are being inundated with complaints from prescribers because paper prescriptions are being denied by pharmacists primarily issued by prescribers who are exempt from having to issue electronically. The complaints are primarily coming from prescribers who will not issue more than 150 prescriptions in the calendar year. In addition to that exemption, below is a summary of the exemptions under the law.
Importantly, any pharmacist who dispenses in good faith based upon a valid prescription that is not prescribed electronically may be exempt from any disciplinary action. A pharmacist is not required to ensure or be responsible for ensuring the prescriber’s compliance, nor may any other entity or organization require a pharmacist to ensure the prescriber’s compliance with that subsection.
IRMA and IPhA have prepared and issued detailed guidance. You are strongly encouraged to distribute or utilize this guidance to ensure pharmacy personnel are fully aware of the exemptions under this law.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.