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KMAP BULLETIN: Preferred Drug List and Prior Authorization Updates

Date: 09/19/24

KMAP GENERAL BULLETIN 24174 (PDF)

Preferred Drug List (PDL) Update:

Effective with dates of service on and after August 1, 2024, the following medications are no longer PDL preferred:

  • Hydrocortisone (Ala-Scalp) Lotion
  • Ondansetron 16mg ODT
  • Sacubitril/Valsartan (Entresto® Sprinkle) Caps

Clinical Prior Authorization (PA) Update:

Effective with dates of service on and after September 19, 2023, the following medications require a Clinical PA:

  • Adalimumab-aacf (Idacio) UNBRANDED version
  • Adalimumab-adbm (Cyltezo) UNBRANDED version

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 nonmaintenance (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 September 19, 2023. 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.