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KMAP BULLETIN: Prior Authorization Updates

Date: 03/15/24

KMAP GENERAL BULLETIN 24055 (PDF)

Effective with dates of service on and after March 17, 2024, the following medications require a Clinical Prior Authorization (PA):

  • ADAMTS13, recombinant-krhn (Adzynma) Vial
  • Bimekizumab-bkzx (Bimzelx®) Autoinjector, PFS
  • Cipaglucosidase alfa-atga (Pombiliti) Vial
  • Epcoritamab-bysp (Epkinly) Vial
  • Etrasimod (Velsipity) Tablet
  • Exagamglogene autotemcel (Casgevy) Vial
  • Glofitamab (Columvi) Vial
  • Lovotibeglogene autotemcel (Lyfgenia®) Vial 
  • Miglustat (Opfolda) Capsule
  • Mirikizumab-mrkz (Omvoh) Vial, Pen
  • Nivolumab and relatimab-rmbw (Opdualag) Vial
  • Retifanlimab-dlwr (Zynyz) Vial
  • Secukinumab (Cosentyx UnoReady®) Pen
  • Secukinumab (Cosentyx Sensoready®) Pen
  • Setmelanotide (Imcivree®) Vial
  • Tirzepatide (Zepbound) Pen

Note: Pegunigalsidase alfa-iwxj (Elfabrio) updated retroactive to September 19, 2023.

Effective with dates of service on and after March 17, 2024, the following medications no longer require Clinical PA:

  • Aprepitant (Cinvanti) Vial
  • Aprepitant (Emend® oral) Capsule
  • Fosaprepitant (Emend® IV)

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%, the member will not be given a Grandfather PA.
  • For members currently taking medications considered non-maintenance (acute or seasonal treatments) (For example, acne agents, muscle relaxants, NSAIDs, antihistamines, etc.), no Grandfather PA will be given.

Reference the Prior Authorization - Clinical Criteria page on the Kansas Department of Health and Environment (KDHE) website for Clinical PA information.

Note: The effective date of the policy is March 17, 2024.  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 completion dates once the policy is implemented.