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.

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.

Gov. J.B. Pritzker (D) has signed HB3637, authorizing health care professionals to prescribe any drug approved by the FDA before 2025 that continues to carry World Health Organization approval. The law is designed to safeguard access to abortion medication in the event of future FDA restrictions. 

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

The Women, Infants and Children (WIC) Vendor Relations Unit will host its next Quarterly Vendor Information Conference Call on August 12 from 10:00 am to 11:00 am CST. Please use the following information to access the call: Dial-in Number: 844-291-5490 Access Code: 2902421

This call provides an opportunity for the Department of Human Services to share important program updates, address recent issues and hear general questions or concerns from vendors.

When joining the call, please be prepared to provide your name, company name and WIC Vendor ID (if you represent a specific vendor location).

Key discussion topics have been outlined in the agenda. If you would like to address a specific issue during the call, in addition to the topics on the agenda, please complete the Help IL WIC Improve vendor questionnaire before the call.

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