Date: August 8, 2019
To: Enrolled Pharmacies
Re: Medication Synchronization
As the result of Public Act 100-138, the Illinois Department of Healthcare and Family Services allows synchronization of HFS participants’ prescription medications. This enables patients to make one trip each month to the pharmacy for refills of maintenance medications. The billing guidance contained in this notice applies only to Medical Programs fee-for-service claims.
The Department permits synchronization of prescription drug refills one time per maintenance medication per year. Providers must submit claims to HFS for these synchronized medications with a Submission Clarification Code of “47”. These prescriptions are exempt from participant copayments.
Compound drugs, partial fill/completions and controlled substances are not eligible for medication synchronization. All other claim types are eligible.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.