The State Veterinary Medical Association asked NACDS to remind members that veterinarians have an exemption from the state’s e-prescribing law for the next two years. Please see HB 1358/Public Act 103-0563 (Section 311.6 (b-5, 10). 

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

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.

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.

The Department of Healthcare and Family Services is currently offering several new behavioral health courses through its Provider Assistance and Training Hub (PATH). All courses are open for registration in the Medicaid Technical Assistance Center (MTAC) Learning Center. Create or sign into your MTAC account at https://go.uillinois.edu/MTAC to access all available training courses. For training questions, please contact PATH-BH@illinois.edu. For questions about the MTAC Learning Management system, please reach out to omi.training@uillinois.edu. 

Also in Illinois, the Illinois Legislative Black Caucus Foundation (ILBCF) is looking to host a statewide Veteran’s Day Event November 10-12. Its goal is to give away 1,500-2,000 bags of groceries to Black Veterans throughout the state. To date, they have secured a donation of 500 bags of groceries and are trying to secure 1,000-1,500 additional. They say gift cards would be helpful as well. The groceries would be distributed throughout the state but particularly East St. Louis, Peoria, Champaign, Chicago (south and west sides) and the south suburbs of Chicago/Will County. If you are interested in supporting this event, please contact Tiffany Hightower, the Executive Director of the ILBCF at executivedirector@ilbcf.org or 773-896-6805.  

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

Effective October 1, 2023, due to the increased prevalence of Respiratory Syncytial Virus (RSV), providers may submit prior approval requests for Synagis (palivizumab). This applies to customers covered under Medicaid fee-for-service or a managed care plan. Providers should contact the appropriate managed care plan for approval guidance. For fee-for-service customers, providers must complete the Drug Authorization Request Form for Synagis and fax it to the Pharmacy Unit at 217-524-7264. Approval for the early dosing will be provided for those customers who meet the Department’s Synagis Prior Approval Criteria.  

For both fee-for-service and managed care customers, the approval period for the dose will be effective through February 29, 2024. The Department will continue to monitor for necessary changes. This is a temporary deviation from the usual Synagis guidelines, and the Department will continue to monitor RSV prevalence and respond accordingly. 

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, or to the appropriate managed care plan.  

Also in Illinois, the Department of Healthcare and Family Services (HFS) is notifying all pharmacies of billing instructions for the new commercial COVID-19 vaccines now in circulation. These instructions apply to the fee-for-service program only.  

As HFS is still finalizing programming for the administration fee for the COVID vaccine, pharmacies cannot use “MA” in the Professional Service Code Field, nor add the administration fee until the new programming is complete. Pharmacies can still provide COVID-19 vaccinations and submit claims to HFS for reimbursement for the cost of the vaccination plus a dispensing fee as they would for other vaccinations that do not pay an administration fee.  

Once the programming is complete, pharmacies can then void and rebill for services rendered to receive the full payment including the applicable administration fee.  

A provider notice will be sent to pharmacies once programming is complete and pharmacies can bill for the administration fee. The void and rebill process to receive full payment for claims that were submitted without receiving the administration fee can commence at that time.  

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. 

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

HB 3203, legislation that authorizes pharmacists or retailers to sell fentanyl test strips over the counter and authorizes county health departments to distribute fentanyl test strings at their facilities for no fee was signed by Gov. JB Pritzker (D) on August 4th and goes into effect January 1, 2024.  

Also signed by Gov. Pritzker (D) on August 4th was HB 3631, legislation that prohibits a pharmacy benefit manager (PBM) from retaliating against a pharmacist or pharmacy for disclosing information in a court, administrative hearing, before a legislative commission or committee, or any proceeding, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of state or federal law, rule or regulation. The bill also prohibits a PBM from retaliating against a pharmacist or pharmacy for disclosing information to a government or law enforcement agency, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of state or federal law, rule, or regulation. A pharmacist or pharmacy must make reasonable efforts to limit the disclosure of confidential and proprietary information. This measure went into effect July 1, 2023.  

Also in Illinois, the Illinois Department of Healthcare and Family Services (HFS) has issued notice that implements Public Act 102-1051 which allows pharmacists to be reimbursed for human immunodeficiency virus (HIV) pre- and post-exposure prophylaxis assessment and consultation. This new policy is effective with dates of service on and after January 1, 2023, and applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCOs). 

In accordance with the Act, the Department of Healthcare and Family Services (HFS) will cover patient care services provided by a pharmacist for HIV pre- and post-exposure prophylaxis assessment and consultation at 85% of the physician rate. Pharmacists must have a standing order with an associated physician, be licensed to practice medicine in all its branches and be enrolled in the Illinois Medical Assistance Program to perform the assessment and consultation services.  

HFS has also issued notice informing pharmacies that HFS has opened additional procedure codes that may be billed for pharmacists providing hormonal contraceptive assessment and consultation services. This applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organization (MCO) plans. 

By provider notice dated October 31, 2022, the Department of Healthcare and Family Services (HFS) notified providers that patient care services provided by a pharmacist for hormonal contraceptive assessment and consultation would be covered at 85% of the physician rate. HFS identified CPT procedure code 99401 – Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes, for billing. Modifier FP must be billed in conjunction with procedure code 99401.  

Effective retroactive to August 1, 2022, pharmacies may bill on behalf of pharmacists for one of the following Evaluation and Management procedure codes with the FP modifier, in addition to 99401, for the assessment component of the family planning service. 

HFS has been notified of an extreme shortage of Cisplatin, which has been determined to constitute a medical emergency for those patients in need. In accordance with the actions by the Food and Drug Administration (FDA), a non-FDA approved Cisplatin, manufactured by Qilu Pharmaceutical Company in conjunction with Apotex Corporation, can be distributed into and within the State of Illinois and will be reimbursable for Illinois Medicaid enrolled providers. Additional information can be found here. 

Finally in Illinois, Snap EBT (Electronic Benefit Transfer) data theft has been on the rise in stores across the Country. The Department of Human Services (IDHS) has confirmed a recent surge in compromised cards in Illinois. Retailers are urged to immediately contact their POS (Point of Sale) vendor, local police, FNS and IDHS if skimming devices are discovered, or your pin pads have been compromised in any way. With prompt notification, IDHS can move to protect cardholders before their benefits are stolen. Tracking skimming after the theft is exceedingly difficult to do. Contact IDHS at: dhs.ebtretailer.reportfraud@illinois.gov  

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

In 2022, the General Assembly passed Public Act (P.A.) 102-0700, which suspended the state’s 1 percent (1%) low rate of sales and use tax on retail sales of groceries from July 1, 2022, through June 30, 2023. The 1% grocery sales tax suspension ended on Friday, June 30. Retailers are now required to collect and remit the 1% sales tax on groceries. 

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

Gov. JB Pritzker (D) has signed SB 303. https://www.ilga.gov/legislation/billstatus.asp?DocNum=303&GAID=17&GA=103&DocTypeID=SB&LegID=144008&SessionID=112 Effective January 1, 2024, it will be the joint responsibility of a pharmacy and its pharmacist–in–charge to ensure that all new pharmacy technicians are educated and trained using a standard nationally accredited education and training program, such as those accredited by the Accreditation Council for Pharmacy Education (ACPE)/the American Society of Health-System Pharmacists (ASHP), or equivalent work experience of 500 hours as a pharmacy technician covering the practice areas as required by the Illinois Pharmacy Practice Act.

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

Due to the access to care issue for bronchodilation medications for customers with asthma and other respiratory issues, the Department of Healthcare and Family Services (HFS) will temporarily remove the prior authorization requirements for generic albuterol sulfate inhalers, effective immediately. Pharmacy providers with questions may contact the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the applicable MCO.

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