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Illinois Medicaid Prior (Rx) Authorization Form

An Illinois Medicaid prior authorization form is submitted by a physician to request Medicaid coverage for a non-preferred drug being prescribed to a patient. In the request, the physician must provide relevant information about the patient's diagnosis and why a drug that is not on the preferred drug list would better serve that patient.
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Fax – 1 (217) 524-7264

Phone – 1 (800) 252-8942

Preferred Drug List – List of pre-approved drugs by the State