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Provider Notice issued 06/30/12

Pharmacy Reimbursement Changes Effective July 1, 2012

To​: ​Participating Pharmacies
​Date: ​June 30, 2012
​Re: Pharmacy Reimbursement Changes Effective July 1, 2012​

As a result of Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, the department is required to reduce pharmacy reimbursement rates by 2.7%. Therefore, the department is reducing its pharmacy reimbursement rates as follows, effective July 1, 2012.

Effective July 1, 2012, pharmacies will be reimbursed at the lesser of:

  1. The pharmacy’s usual and customary charge; or
  2. The department’s maximum price plus the established dispensing fee of $5.50 for generic drugs and $2.40 for brand name drugs.

For legend prescription drugs, the department’s maximum price is calculated at the lowest of:

  1. Wholesale Acquisition Cost (WAC)
  2. The Federal Upper Limit (FUL)
  3. The State Upper Limit, or State Maximum Allowable Cost (SMAC)

Any questions regarding this notice should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs


Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director