Pharmacy Services

Some maintenance drugs must be filled every 90 days at your local Kansas Medicaid pharmacy instead of the previous 30-day supply. This includes long-term medications for conditions such as:

• High blood pressure
• Cholesterol
• Heart disease
• And more

Visit the KanCare website to find out if your medication is on the 90-day list (PDF). If your medication is on this list, it must be filled as a 90-day supply.

*Members with long-term care, foster care, dual, unmet spenddown eligibility or adherence packaging will not be required to fill every 90 days.

Sunflower offers special programs that help you stick to your medications and avoid mistakes. These programs are designed to improve your health. We support you in managing long-term conditions and make sure you get the right medications at the right time to stay healthy.

Medication Therapy Management (MTM)

Our MTM programs help members understand and manage their medications. We work with you to improve your healthcare routine and get the best results from your treatments.

We have a large network to give members access to many types of pharmacies, including retail, mail-order and specialty pharmacies. This makes it easy for you to get your medications. We work closely with our pharmacy programs to make sure they meet your needs as a Sunflower member.

Sunflower Health Plan covers certain prescription drugs and over-the-counter (OTC) drugs when prescribed by Sunflower providers. We do not cover all drugs. Some need prior authorization. Some drugs have limits on age, dosage or quantities.

The KanCare Preferred Drug List (PDL) is the list of some covered drugs. The Kansas Medical Assistance Program (KMAP) works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at retail pharmacies. It also applies to mail-order pharmacies. The KanCare PDL is continually evaluated by the Kansas Preferred Drug List Advisory Committee, composed of practicing physicians and pharmacists, to promote the appropriate and cost-effective use of medications.

Only drugs that are part of the listed therapeutic classes are affected by the PDL. Therapeutic classes not listed are not part of the PDL and will continue to be covered as they always have for the Kansas Medical Assistance Pharmacy Program.

Your doctor will need to ask for prior approval for some drugs before the medication can be given to you at the pharmacy. These drugs are on the prior approval list.

If a prescription you take is no longer preferred, you will be told by your doctor, Sunflower, or your pharmacy. You may need to switch to a different medication. You can also ask your doctor to ask for a prior authorization to stay on your current medication.

If you get a letter in the mail from Sunflower Health Plan, please read it carefully. You should talk to your doctor about it at your next visit or call your doctor’s office. If you try to refill your prescription before your next visit, the pharmacy may tell you that your medication needs prior authorization.

We will work with your doctor to make sure you get the medication you need. You will not lose drug coverage. You will keep using the same Medicaid ID.

You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your Sunflower ID Card.

To find a pharmacy that is in the Sunflower Health Plan network, you can use the Find a Provider Tool.

1. Type in your city or zip code.
2. Then click Update.
3. Choose Other and type the name of your pharmacy.
4. You can also select the pharmacy type in the Select Specialty area.

This will show a list of pharmacies in the Sunflower network.

What is a Specialty Medication?

A specialty drug is a prescription drug that needs special handling, administration or supervising. These are often only ordered through a specialty pharmacy.

What is a Specialty Pharmacy?

A specialty pharmacy provides services and medications needed to treat members with chronic, complex or rare conditions. The medication provided by specialty pharmacies is often considered high-touch or high-cost. The services provided by specialty pharmacies are done by highly trained professionals and are more extensive than regular retail pharmacies offer. Specialty pharmacy services can include clinical help, such as training on how to take medication, and financial support, like applying for copay assistance.

Access to Specialty Medications

Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies. We make sure members have access to the treatments you need with the guidance of a dedicated pharmacy team.