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KMAP BULLETIN: Preferred Drug List Update

Date: 11/05/20

KMAP GENERAL BULLETIN 20225 (PDF)

There is a Preferred Drug List (PDL) update effective November 1, 2020. Reference the Preferred Drug List (PDL) page on the Kansas Department of Health and Environment (KDHE) website.

The following medications are non-preferred and require a PDL Prior Authorization (PA):

  • Filgrastim (Neupogen) Syringe and Vial
  • Filgrastim (Zarxio) Syringe
  • Fluticasone (Armonair™ Digihaler®) Inhaler
  • Insulin lispro (Humalog® JUNIOR KwikPen®) BRAND ONLY Pens
  • Insulin lispro protamine/insulin lispro (Humalog®75-25 MIX)(BRAND ONLY) Pen
  • Pegfilgrastim (Neulasta®) Syringe
  • Pegfilgrastim (Neulasta® OnPro) Syringe

*Grandfathering applies, where applicable in policy.

The following medications are now preferred and a PDL PA is no longer required:

  • Methylphenidate (Methylin Solution®)

A Grandfather PA process is in place for KanCare patients, according to the following guidelines.

  • For members currently taking a maintenance drug that newly requires a PA and the member has been 80% adherent, the member will receive a Grandfather PA.
  • For members who have filled a maintenance drug that newly requires a PA and the member has filled the medication once or with an adherence rate of less than 80%, these members will not be given a Grandfather PA.
  • For members currently taking medications considered nonmaintenance (acute or seasonal treatments) (Examples: Acne agents, muscle relaxants, NSAIDs, Antihistamines, etc.), No Grandfather PA will be given.

Note: The effective date of the policy is November 1, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing.