Pharmacy

Sunflower Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Sunflower members. Sunflower covers prescription medications and certain over-the-counter medications with a written order from a Sunflower 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.

Use the KanCare Preferred Drug List to find more information on the drugs that are covered.

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.

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.

Learn More

Pharmacy Forms

Medication Requests - Choose the appropriate medication request form below:

  • KanCare Medication Request Forms
    • Drug-Specific PA Forms - Forms designed to include drug-specific prior authorization criteria.
    • Universal/General PA Forms - Generic forms that can be used for any drug prior authorization request. Please review drug criteria and complete form with relevant information.
  • Envolve Pharmacy Medication Forms
    • 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.
  • Buy and Bill Medication Request Form
    • 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.

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.

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

Effective 7/1/2017

  • Trulence
  • Emflaza
  • Ibrance
  • Soliqua
  • Xultophy
  • Long-acting opioids at units per day above DUR-determined quantity limit
  • Multiple concurrent tricyclic antidepressants
  • Opioid dependency agents such as Suboxone, Zubsolv, Bunavail, Subutex
  • Eucrisa
  • Rubraca
  • Qtern
  • Siliq
  • Rhofade

Effective 4/1/2017

  • New Prior Authorization
    • Amrix
    • Bonjesta
    • Zinplava
  • New Step Therapy
    • Aspirin-PPI Combo
    • GoNitro/Nitroglycerin Spray
    • Sulfonylurea-thiazolidinedione Combo
    • Zegerid
    • Zolpimist

Effective 1/1/2017

  • 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

Please refer to the KDHE website for detailed information regarding clinical prior authorization criteria.

Effective 06/15/2016

  • Strensiq (asfotase alfa)
  • Zurampic (lesinurad)
  • Kanuma (sebelipase alfa)

Effective 04/15/2016

  • 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)

Effective 11/13/2015

  • CFTR Modulators – Kalydeco, Orkambi
  • Cysteamine Agents – Cystaran, Procysbi
  • Imbruvica
  • Kadcyla
  • Kyprolis
  • Opdivo
  • Somavert
  • Vantas
  • Viberzi
  • Zelboraf

 

Effective 6/15/2016

  • Strensiq (asfotase alfa)
  • Zurampic (lesinurad)
  • Kanuma (sebelipase alfa)

Effective 6/15/2016

  • Strensiq (asfotase alfa)
  • Zurampic (lesinurad)
  • Kanuma (sebelipase alfa)