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Four Prescription Policy Prior Authorization Request Form

Four Prescription Policy Prior Authorization Request Form 2025

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The document outlines the Four Prescription Policy by the Illinois Department of Healthcare and Family Services, which aims to encourage healthcare providers to review patients' medication regimens to minimize unnecessary prescriptions and poly-pharmacy. It details the process for requesting prior authorization for necessary medications, specifies drugs that do not require prior approval, and promotes the use of the Medical Electronic Data Interchange (MEDI) System for submitting requests.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can Medicaid deny a prescription?

Medicaid patients are increasingly facing procedural prescription denials, meaning their health plans refuse to cover medications for administrative reasons like early refills, plan limits on pill amounts or prior authorization rules.

Does Illinois Medicaid cover prescriptions?

The Illinois Medicaid program covers prescription drugs, as well as some over-the-counter (OTC) products, made by manufacturers that have a signed rebate agreement with the federal Centers for Medicare and Medicaid Services (CMS).

What is a prior authorization request form?

Your doctors office is responsible for obtaining prior authorization. They will submit a request to your insurance provider to get approval, whether its for a service or for a medication. Usually, your physician will have a good idea of whether they need to get prior authorization.

What is the maximum out of pocket for Medicare prescription drugs?

In a single calendar year (January December), youll never pay more than: The total amount you would have paid out of pocket to the pharmacy if you werent participating in this payment option. The Medicare drug coverage annual out-of-pocket maximum ($2,000 in 2025).

Is the 4 prescription limit allowed for Medicaid in Illinois?

Drugs That May Require Prior Authorization Drug ClassDrugs in Class Anticoagulants Eliquis, Pradaxa, Xarelto Antipsoriatic Agents Otezla, Stelara, Taltz, Tremfya Apokyn, Kynmobi Apokyn, Kynmobi Arcalyst Arcalyst240 more rows

What is the 28 day prescription rule?

Its common to see a 2-day window for refilling these types of medications early. Some people even call it the 28 day prescription rule for controlled substances they fill monthly. In other words, there needs to be at least 28 days between refills of 30-day prescriptions.

Four Prescription Policy Prior Authorization Request Form 2025

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