Illinois Healthcare and Family Services Illinois Healthcare and Family Services  
www.hfs.illinois.gov/
Bruce Rauner, Govenor
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Pharmacy Information
Prior Approval Process Information
Four Prescription Policy Override Request and Status Inquiry
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Four Prescription Limit Form
General Form
MEDI System
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Refill Too Soon Form
Fax:217-524-7264
Preferred Drug List
Approval Criteria
Illinois Healthy Women Formulary
Vaccines for Children
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ACE Inhibitor Combinations
ACE Inhibitors
Calcium Channel Blockers
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H2 Blockers
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Narcotics
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Topical Corticosteroids
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Label Name Generic Name BrandGeneric 
HYDROCODON-ACETAMINOPHEN 5-500 HYDROCODONE/ACETAMINOPHEN PA RequiredPA Required
HYDROCODON-ACETAMINOPHN 10-650 HYDROCODONE/ACETAMINOPHEN PA RequiredPA Required
HYDROCODON-ACETAMINOPHN 10-325 HYDROCODONE/ACETAMINOPHEN PA RequiredNo PA Required for 12 years old and over.
PA required for all other ages
HYCET 7.5 MG-325 MG/15 ML SOLN HYDROCODONE/ACETAMINOPHEN PA RequiredNo PA Required for 02 years old and over.
PA required for all other ages
HYDROCODON-ACETAMIN 7.5-325/15 HYDROCODONE/ACETAMINOPHEN PA RequiredNo PA Required for 02 years old and over.
PA required for all other ages
HYDROCODONE-ACETAMIN 2.5-167/5 HYDROCODONE/ACETAMINOPHEN Not AvailableNo PA Required for 02 years old and over.
PA required for all other ages
ZAMICET 10-325 MG/15 ML SOLN HYDROCODONE/ACETAMINOPHEN PA RequiredNot Available
HYDROCODONE-ACETAMIN 10-325/15 HYDROCODONE/ACETAMINOPHEN Not AvailablePA Required
HYDROCODONE-ACETAMIN 5-163/7.5 HYDROCODONE/ACETAMINOPHEN Not AvailablePA Required
LORTAB 10 MG-300 MG/15 ML ELXR HYDROCODONE/ACETAMINOPHEN PA RequiredNot Available
HYDROCODON-ACETAMIN 7.5-325/15 HYDROCODONE/ACETAMINOPHEN PA RequiredPA Required
HYDROCODONE-ACETAMIN 2.5-108/5 HYDROCODONE/ACETAMINOPHEN Not AvailablePA Required
HYDROCODONE-ACETAMIN 5-217/10 HYDROCODONE/ACETAMINOPHEN Not AvailablePA Required
HYDROCODON-ACETAMINOPH 2.5-325 HYDROCODONE/ACETAMINOPHEN PA RequiredPA Required
VERDROCET 2.5-325 MG TABLET HYDROCODONE/ACETAMINOPHEN PA RequiredPA Required
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*This site is designed to provide information regarding Medicaid covered drugs. The search function contains prescription drugs covered by Medicaid, including those that require prior authorization. This information is current as of Thursday, January 12, 2017. For additional information please call 1-800-252-8942.

It is important to note that individual client eligibility may limit coverage for some drug categories.

Please Note: This site should be used for reference only; it is not to be used to verify payment of a particular product by Illinois Department of Healthcare and Family Services. It is intended as an education and information resource.
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