Disclaimer: Any medication or drug class not listed on this page has non-sharable internal criteria or is reviewed on a case-by-case basis by a clinical pharmacist.
The DOC hyperlinks in the tables below provide access to the full criteria documents. These links will direct you to a Box.com folder maintained by the University of Illinois Chicago - Retzky College of Pharmacy for secure document storage.
|
Medication: Brand (generic) |
Criteria (DOC) |
Program |
Effective |
Status |
|
Adakveo (crizanlizumab) |
FFS |
10-07-2022 |
Published |
|
|
Agamree (vamorolone) |
FFS |
04-03-2025 |
Published |
|
|
Duvyzat (givinostat) |
FFS |
11-14-2025 |
Published |
|
|
Ebglyss (lebrikizumab) |
FFS |
04-03-2025 |
Published |
|
|
Imcivree (setmelanotide) |
FFS |
10-01-2025 |
Published |
|
|
Leqembi (lecanemab) |
FFS |
03-14-2023 |
Published |
|
|
Ocrevus (ocrelizumab) |
FFS |
04-03-2025 |
Published |
|
|
Ohtuvayre (ensifentrine) |
FFS |
04-29-2025 |
Published |
|
|
Radicava (edaravone) |
FFS |
05-05-2025 |
Published |
|
|
Sensipar (cinacalcet) |
FFS |
08-12-2022 |
Published |
|
|
Spinraza (nusinersen) |
FFS |
04-03-2025 |
Published |
|
|
Vyjuvek (beremagene geperpavec-svdt) |
FFS |
01-01-2025 |
Published |
|
|
YCANTH (cantharidin) |
FFS |
01-21-2025 |
Published |
|
Drug Class |
Criteria (DOC) |
Program |
Effective |
Status |
|
ADHD in Adults > 19 years old |
FFS |
04-14-2023 |
Published |
|
|
ADHD in Children/Adolescents < 19 years old |
FFS |
08-12-2022 |
Published |
|
|
Atypical Antipsychotic Medications in Children < 8 years old |
FFS |
05-01-2023 |
Published |
|
|
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulators |
FFS |
08-30-2022 |
Published |
|
|
Continuous Glucose Monitors (CGM) |
FFS |
12-01-2024 |
Published |
|
|
Calcitonin-gene-related peptide (CGRP) antagonists |
FFS |
05-19-2023 |
Published |
|
|
Glucagon-like Peptide-1 Receptor Agonist (GLP-1 RA) and Glucose-dependent Insulinotropic Polypeptide (GIP) Receptor Agonist |
FFS |
04-29-2025 |
Published |
|
|
Hereditary Angioedema (HAE) Agents |
FFS |
09-07-2022 |
Published |
|
|
Potassium Exchange Resins |
FFS |
01-12-2024 |
Published |
|
|
Long-acting Injectable (LAI) Antipsychotics |
FFS |
05-22-2025 |
Published |
|
|
Oral Isotretinoin Agents |
FFS |
05-17-2023 |
Published |
|
|
Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Inhibitors |
FFS |
03-09-2023 |
Published |
|
|
Proton Pump Inhibitors (PPIs) |
FFS |
01-21-2025 |
Published |
|
|
Pulmonary Fibrosis Agents |
FFS |
05-05-2025 |
Published |
|
|
Testosterone (injectable and transdermal) Agents |
FFS |
12-22-2022 |
Published |
|
|
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors |
FFS |
04-03-2025 |
Published |
|
Medication |
Criteria (DOC) |
Program |
Effective |
Status |
|
CORIFACT: (Factor XIII Concentrate (Human)) |
FFS |
10-31-2025 |
Published |
|
|
Factor VIII (recombinant), Long-Acting Agents |
FFS |
10-31-2025 |
Published |
|
|
Factor VIII/VWF Complex Agents |
FFS |
10-31-2025 |
Published |
|
|
Factor IX (recombinant) Agents |
FFS |
10-31-2025 |
Published |
|
|
Hemlibra (emicizumab-kxwh) |
FFS |
10-31-2025 |
Published |
|
|
Hemofil M: (Antihemophilic Factor VIII (Human), Method M) |
FFS |
10-31-2025 |
Published |
|
|
Hympavzi: (marstacimab-hncq) |
FFS |
10-31-2025 |
Published |
|
|
Koāte (Antihemophilic Factor (Human)) |
FFS |
10-31-2025 |
Published |
|
|
NovoSeven RT: (coagulation Factor VIIa (recombinant)) |
FFS |
10-31-2025 |
Published |
|
|
Qfitlia: (fitusiran) |
FFS |
10-31-2025 |
Published |
|
|
Sevenfact: (coagulation Factor VIIa (recombinant)-jncw) |
FFS |
10-31-2025 |
Published |
Below are the four statewide, one Cook County only, managed care health plans under the Illinois Medicaid program, each of which publishes its own prior-authorization/criteria webpage: