The Department of Healthcare and Family Services issued a Provider Notice RE: Rybelsus Tablets to Ozempic Tablets. This change will apply to both the fee-for-service (FFS) program and Managed Care Organizations (MCOs) plans. There are no changes to Ozempic injections. 

Novo Nordisk informed the Department of Healthcare and Family Services (HFS) that it will discontinue all strengths of Rybelsus tablets, requiring patients to be transitioned to Ozempic tablets. Beginning in May 2026, shipments of Rybelsus tablets to wholesalers will cease, with existing inventory expected to become limited starting in July 2026.  

Please see notice for details. Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 or the applicable MCO.  

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

The Department of Healthcare and Family Services (HFS) Bureau of Professional and Ancillary Services (BPAS) occasionally receives requests from clinicians in the provider community for individual drug reviews. To ensure requests for reviews are fair, balanced and relevant to the Medicaid Preferred Drug List (PDL), the BPAS has established procedures for handling these requests. After the BPAS receives the request for a drug review, the BPAS pharmacy staff establish the appropriateness of the request. The review takes place over a three-month period, beginning from the date the drug review is requested. Reviews are evaluated both clinically and financially. A recommendation may be presented to the Drugs & Therapeutics (D&T) Advisory Board at the earliest opportunity. 

Complete Drug Review Request 

Preferred Drug List, effective April 1  

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

The Department of Financial and Professional Regulation released the Compliance Capsule Spring 2026 newsletter, providing regulatory updates and compliance information for licensed professionals, including pharmacists.

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

The Illinois Retail Merchants Association (IRMA) has opened the online application for the its Pharmacy Assistance Program, which is supported by a grant from the Department of Commerce and Economic Opportunity (DCEO). The program will provide direct financial assistance to qualifying pharmacies to help expand and sustain pharmacy services in communities across the state that need them most. 

This initiative is designed to support pharmacies serving underserved and vulnerable areas, helping ensure that patients across the state continue to have access to essential medications and pharmacist-provided care. 

Pharmacies interested in participating are encouraged to review the eligibility requirements and submit an application through the IRMA website. 

Applications must be submitted no later than midnight on March 31, 2026. 

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

Effective December 31, 2025, generic Novolog (insulin aspart) and generic Tresiba (insulin degludec) vials and pens were discontinued by the manufacturer. In response, the Department of Healthcare and Family Services (HFS) has moved the brand name Humalog (insulin lispro) products to preferred status and will continue to maintain the generic insulin lispro and brand name Lantus (insulin glargine) products as preferred on the Preferred Drug List (PDL).  

To ensure that interruption in treatment is avoided, pharmacies are encouraged to contact the patient's doctor to request a change to a preferred rapid acting insulin agent. Pharmacies may continue to dispense generic insulin until stock is exhausted.  

Also in Illinois, effective April 15, Healthcare and Family Services (HFS) will once again designate Contour Plus Blue blood glucose meters and test strips as preferred agents on the Preferred Drug List (PDL). In the Provider Notice issued 10/24/2025, prior authorization was temporarily removed for the non-preferred brands, OneTouch, Accu-Chek and FreeStyle blood glucose meters and blood glucose test strips due to shortages of Contour Plus Blue products. Healthcare and Family Services (HFS) has been in communication with Ascensia Diabetes Care, the manufacturer of Contour Plus Blue products, which has confirmed that the out-of-stock issues experienced last year have been rectified.  

If Illinois Medicaid customers received OneTouch, Accu-Chek or FreeStyle blood glucose meters and blood glucose strips since October 24, 2025, a new prescription is required to change over to the Contour Plus Blue products. Prior authorization is necessary for OneTouch, Accu-Chek or FreeStyle products.  

This change will apply to Fee-For-Service (FFS) and Managed Care Organizations (MCOs).  

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 or the applicable MCO.  

Also in Illinois, the Illinois Retail Merchants Association (IRMA) announced the availability of an online application for the Pharmacy Assistance Program. Supported by a grant from the Department of Commerce and Economic Opportunity, IRMA will provide direct payments to qualifying pharmacies in the state to increase the availability of pharmacy services in the state's underserved communities. Details about the application and qualifications can be found by clicking the button below. Pharmacies are encouraged to apply soon as the application period closes at midnight on March 31. For questions regarding the program or the application, please email info@irma.org.  

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

2026 Critical Access Pharmacies eligibility list is available online as well as the most recent Medicaid Preferred Drug List.

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

The purpose of this Provider Notice is to inform pharmacy providers that the claims adjudication system is now able to process and pay compound claims. The processing system had been paying compound claims at zero since the Change Healthcare outage in March 2024.  

At this time, pharmacy providers are encouraged to void and rebill those claims that were either paid at zero or held pending restoration. This applies to fee-for-service (FFS) billing only.  

Please call the Bureau of Professional and Ancillary Services at 877-782-5565 and speak to a pharmacy consultant to obtain any necessary overrides on rejections that may occur while rebilling these claims.

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

Effective October 1, the Department of Health and Family Services updated the Medicaid Preferred Drug List.

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

In accordance with Public Act 104-0027, the Department of Healthcare and Family Services (HFS) is implementing a major update to the Critical Access Pharmacy (CAP) program. Effective January 1, 2026, the revised CAP program will consolidate the two existing initiatives into a single, streamlined model. See Provider Notice Issued 09/29/2025 for details. To minimize confusion during the transition, the Department has established a dedicated email address for all CAP-related inquiries.

Also in Illinois, the WIC [Special Supplemental Nutrition Program for Women, Infants and Children] program does not anticipate any disruption to its operations in the event of a federal government shutdown. The program continues to have funds available for food, and vendors should expect no issues with selling WIC products and receiving payment. As of October 1, 2025, businesses should proceed as usual for all Illinois WIC transactions.

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