2018 ILLINOIS MEDICAID COVERAGE OF HIV AND HEPATITIS C MEDICATIONS APRIL 2018 PLAN s NRTI HEP C FFS BCBS Meridian Molina Illini Care Harmony WellCare Next Level County Care 2 of 6 3 of 6 3 of 6 4 of 6 5 of 6 6 of 10 9 of 10 9 of 10 10 of 10 8 of 10 10 of 10 10 of 10 7 of 10 3 of 7 6 of 7 1 of 7 5 of 7 2 of 7 1 of 7 3 of 7 3 of 7
FEE FOR SERVICE S : 2 OF 6 : 2 OF 2 : 3 OF 6 NRTI/: 6 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NON- NON- IBILD NON- NON- NON- NON- NON- NON- EVIR NON- NON- NON- NON- NON- NON- NON- NON- SOURCE: HTTPS://WWW.ILLINOIS.GOV/HFS/SITECOLLECTIONDOCUMENTS/PDLFINAL412018.PDF DATE ACCESSED FOR ALL: 3/20/2018 EFFECTIVE DATES: 4/1/2018
MERIDIAN S : 3 OF 6 : 2 OF 2 : 4 OF 6 NRTI/: 9 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NON NON IBILD NON NON NON NON EVIR NON NON NON NON NON NON NON SOURCE: HTTPS://CORP.MHPLAN.COM/CONTENTDOCUMENTS/DEFAULT.ASPX?X=K1OYL8S19ZZ65BYDUXXQ/KGZWPGVIGQTNJAA/+Y14E3C/NSCBLCM/7YSBD7EGAA68CJVPWR9RN+EXJBWKLC6GG== EFFECTIVE DATES: 2/17/2018
BCBS S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 9 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT (30P/30D) (30P/30D) (30P/30D) (30P/30D) IBILD (30P/30D) (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (VARIOUS) EVIR NON (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (30P/30D) (VARIOUS) (VARIOUS) (VARIOUS) NON SOURCE: HTTPS://WWW.BCBSIL.COM/MMAI/PDF/MMAI_DRUG_LIST_IL.PDF EFFECTIVE DATES: 1/2018
MOLINA S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 10 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT (30P/MONTH) (30P/MONTH) (30P/MONTH) (30P/MONTH) IBILD (30P/MONTH) (30P/MONTH) (VARIOUS) (60P/MONTH) (30P/MONTH) (VARIOUS) (VARIOUS) (30P/MONTH) (VARIOUS) (VARIOUS) NON (30P/MONTH) (VARIOUS) EVIR (VARIOUS) (30P/MONTH) (30P/MONTH) (VARIOUS) (VARIOUS) (30P/MONTH) (30P/MONTH) (VARIOUS) (VARIOUS) (60P/MONTH) NON NON SOURCE: HTTP://WWW.MOLINAHEALTHCARE.COM/MEMBERS/IL/EN-US/PDF/MEDICAID/FORMULARY.PDF EFFECTIVE DATES: 4/2018
ILLINICARE S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 8 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NOTES (1/DAY) (1/DAY) (1/DAY) (1/DAY) IBILD (1/DAY) (VARIOUS) (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) AT LEAST 18 YR (VARIOUS) EVIR NON NON (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) (1/DAY) (VARIOUS) (VARIOUS) (VARIOUS) NON (1/DAY) (1/DAY) NON NON NON NON SOURCE: HTTPS://WWW.ILLINICARE.COM/CONTENT/DAM/CENTENE/ILLINICARE%20HEALTH/MEDICAID/PDFS/ILLINICARE%20PDL%20SEPT-17%20FINAL.PDF EFFECTIVE DATES: 9/2017
HARMONY WELLCARE S : 6 OF 6 : 2 OF 2 : 5 OF 6 NRTI/: 10 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NOTES (31P/31D) (31P/31D) IBILD (31P/31D) (31P/31D) 3 ALTERNATIVE GENERICS (62P/31D) NON (62P/31D) (31P/31D) (VARIOUS) EVIR (31P/31D) (VARIOUS) (31P/31D) (31P/31D) NON NON NON NON NON NON SOURCE: HTTPS://WWW.WELLCARE.COM/ILLINOIS/MEMBERS/MEDICAID-PLANS/HARMONY-HEALTH-PLAN/HARMONY-SETTINGS/HARMONY-DRUG-SEARCH-PAGE EFFECTIVE DATES: 3/2018
NEXTLEVEL S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 10 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT (1/DAY) (1/DAY) (1/DAY) IBILD (1/DAY) (6/DAY) (1/DAY) (10.67 ML/DAY) (12/DAY) (1/DAY) (12 ML/DAY) (VARIOUS) (1/DAY) (VARIOUS) EVIR (VARIOUS) (1/DAY) (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) (1/DAY) (VARIOUS) (VARIOUS) (VARIOUS) NON (1/DAY) (1/DAY) NON NON NON (3/DAY) SOURCE: HTTPS://NEXTLEVELHEALTHIL.COM/WP-CONTENT/UPLOADS/2018/01/2018_DRUG-FORMULARY-LIST_WEBSITE.PDF EFFECTIVE DATES: 3/1/2018 *COOK COUNTY ONLY
COUNTY CARE S : 5 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 7 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NON IBILD NON EVIR NON NON NON NON NON NON NON SOURCE: HTTP://WWW.COUNTYCARE.COM/PDL EFFECTIVE DATES: NOT STATED *COOK COUNTY ONLY Information collected by AIDS Foundation of Chicago, March 2018. Contact Daniel Frey, dfrey@aidschicago.org. DISCLAIMER: To help people with HIV choose Medicaid health insurance plans, the AIDS Foundation of Chicago (AFC) has collected information on HIV and Hepatitis C medications. Keep in mind: Do not rely solely on the information in this document to choose a plan it is only a guide. Consult a trained enrollment assister for help in selecting a plan. You can reach AFC s navigators at 312-784-9060. Always verify medication coverage directly with a plan before enrolling. Insurance companies can change their coverage without notifying consumers.