ALL COMMERCIAL HEALTH INSURERS : Company Bulletin 2021-09 – Uniform Electronic Prior Authorization Form for Prescription Benefits (50 Ill. Adm. Code Part 2018)

Springfield Office 320 W. Washington Street Springfield, Illinois 62767 (217) 782-4515 Chicago Office 122 S. Michigan Ave., 19th Floor Chicago, Illinois 60603 (312) 814-2420 Illinois Department of Insurance JB PRITZKER Governor DANA POPISH SEVERINGHAUS Acting Director COMPANY BULLETIN TO: ALL COMMERCIAL HEALTH INSURERS FROM: Dana Popish Severinghaus, Acting Director of Insurance Date: June 25, 2021 RE: Company Bulletin 2021-09 – Uniform Electronic Prior Authorization Form for Prescription Benefits (50 Ill. Adm. Code Part 2018) ____________________________________________________________________________________ As enacted by Public Act 101-463, 215 ILCS 5/364.3 the Illinois Department of Insurance (“the Department”) was required to develop a uniform electronic prior authorization form for prescription drug benefits to be used by commercial insurers. The Department convened and facilitated workgroup meetings comprised of Illinois insurance companies and various health care providers representing physicians, psychiatrists, and pharmacists. The meetings were held on April 17, 2020, May 15, 2020, and June 19, 2020, via WebEx conference calls. To implement the form, the Department created a rule prescribing its contents. After receiving a Certification of No Objection from the Joint Committee on Administrative Rules, the Department filed the final version of the rule with the Illinois Secretary of State, which has been adopted as 50 Ill. Adm. Code 2018 with an effective date of June 21, 2021. The adopted rule is appended to this bulletin. Effective July 1, 2021, “every prescribing provider must use the uniform electronic prior authorization form to request prior authorization for coverage of prescription drug benefits and every insurer shall accept the uniform electronic prior authorization form as sufficient to request prior authorization for prescription drug benefits.” 215 ILCS 5/364.3(c). The PDF version of the Illinois Uniform Electronic Prior Authorization Form for Prescription Benefits can be found on the Department’s website next to this Bulletin at: https://insurance.illinois.gov/CB/CompanyBulletins.html. Companies should add their contact and submission information to the first page before making the form available to providers. Springfield Office 320 W. Washington Street Springfield, Illinois 62767 (217) 782-4515 Chicago Office 122 S. Michigan Ave., 19th Floor Chicago, Illinois 60603 (312) 814-2420 Please direct questions regarding this Bulletin to Deputy Director of Health Products Ryan Gillespie at Ryan.Gillespie@illinois.gov. The adopted rule 50 Ill. Adm. Code 2018 follows below. 8024