Sunflower Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Sunflower Health Plan members. Sunflower Health Plan covers prescription medications and certain over-the-counter medications with a written order from a Sunflower Health Plan provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
NEW - Earn Higher Fees with CPPA Accreditation
Sunflower Health Plan is the first plan in the nation to create an innovative incentive for network pharmacy practices to become accredited by the Center for Pharmacy Practice Accreditation (CPPA). Click the button below to learn how our network pharmacies can receive an enhanced professional fee of an additional $0.50 on every claim paid.
Use the KanCare Preferred Drug List to find more information on the drugs that are covered.
Medication Requests - Choose the appropriate medication request form below:
- Medication Request Form - Envolve Pharmacy Solutions, Sunflower’s pharmacy benefit manager, processes pharmacy claims for self-administered (i.e. oral, self-injectable, topical, ophthalmic) drugs. For self-administered medications, use this medication request form.
- Utilization Management Override Form - Use this Envolve Pharmacy Solutions form to request overrides for utilization management (UM) edits.
- Biopharmacy Medication Request Form - Biopharmaceutical medication requests will go through Sunflower. To submit a request for medications that will be administered by a provider (i.e. biopharmacy, home health, outpatient, injectable or infusible medications), use this form.
- Hospice Request for Coverage of Medications Unrelated to Terminal Illness - Use this form related to SHPBN-2016-032 Hospice Pharmacy Benefit
90-Day Maintenance Drug List - Some drugs for long-term conditions will need to be filled every 90 days starting July 1, 2016. Please visit the KanCare website for a full list of 90-day maintenance drugs.
- Adherence Packaging Request Form - Related to 90-day maintenance medication supplies.
Zika Prevention – Insect Repellent Coverage
Select insect repellents are available through the Envolve Pharmacy Solutions/Sunflower pharmacy benefit. Coverage requires a prescription and is limited to one insect repellent per fill and two fills per month. Covered products include Ultrathon 56.7gm, 170 gm and Off Deep Woods 25% spray.
New Drugs Requiring Prior Authorization
- New Prior Authorization
- Adlyxin (lixisenatide)
- Keytruda (pembrolizumab)
- Tecentriq (atezolizumab)
- Xiidra (lifitegrast)
- New Step Therapy
- BB-ARB Combination
- DPP-IV Inhibitor Combination
- Intranasal Antihistamine-Corticosteroid Agent Combination
- NSAID PPI/H2 Combination
- Strensiq (asfotase alfa)
- Zurampic (lesinurad)
- Kanuma (sebelipase alfa)
- Belbuca (buprenorphine buccal film)
- Darzalex (daratumumab)
- Empliciti (elotuzumab)
- Neurokinin 1 (NK-1) Antagonists
- Nucala (mepolizumab)
- Tagrisso (osimertinib)
- Cotellic (cobimetinib)
- Emend (aprepitant)
- Immune Globulins
- Ninlaro (ixazomib)
- Onivyde (irinotecan)
- CFTR Modulators – Kalydeco, Orkambi
- Cysteamine Agents – Cystaran, Procysbi
Please refer to the KDHE website for detailed information regarding clinical prior authorization criteria.
Provider Support from Envolve Pharmacy Solutions (formerly US Script)
Contact the Envolve Pharmacy Solutions Customer Service Center at (800) 460-8988 if you have questions about member eligibility, joining the pharmacy network or Sunflower pharmacy reimbursements.