HFS Notice regarding Four Prescription Per Month policy

Dear providers,

Following is an HFS notice to providers regarding their (HFS') 4 prescription per month policy phase-in. If there are questions, please contact HFS at the number below.

From HFS:

We are writing to you regarding the Department's continued implementation of the Four Prescription Policy. Beginning December 5, 2012, the Department will reduce the number of prescriptions that can be filled in a thirty-day period without prior authorization from nine to seven. As indicated previously, certain drugs do not require prior approval due to the Four Prescription Policy, and you should not request prior approval for those drugs. Drugs that do not require prior approval are listed on our Four Prescription Policy Web page http://www.hfs.illinois.gov/pharmacy/script/ .

Prescribers are strongly encouraged to enter prior approval requests using the Medical Electronic Data Interchange (MEDI) System <http://www.myhfs.illinois.gov/> . To simplify the prior authorization request process, the Department has added the Four Prescription Policy Override Request Form to the MEDI system. Requests entered into the MEDI system go directly into the Department's drug prior approval adjudication database for review by a physician or pharmacist. Requests that are faxed to the Department's Prior Approval Hotline must be data entered after receipt. Prior approval requests are typically reviewed within two hours of being entered into the adjudication database, but can take longer. The MEDI system also allows prescribers to easily check the status of a prior approval request that was entered through the MEDI system, by using the prior authorization number that was assigned when the request was entered. More information about registering for MEDI, and requesting prior approval through the MEDI system, is available on the Department's MEDI Web site http://www.myhfs.illinois.gov/ .

We are continuing to work hard to make this an efficient, expedited, and effective system to benefit our Medicaid participants. To that end, we are also very interested in your feedback on ways to make the process more efficient. Your feedback is imperative to our ability to develop meaningful solutions that improve the process. Any feedback or questions you may have regarding the Four Prescription Policy should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, Option 7 or you can e-mail HFS.Webmaster mailto:HFS.Webmaster@illinois.gov?subject=Pharmacy .