MedicaidReimbursementMedium impact
KMAP BULLETIN: High Dollar Rare Disease Drug List Q4 2025 Update
Kansas Medicaid (KanCare)·KS · Pharmacy, Oncology, Hematology +1 more·Pharmacy
Effective date
Nov 1, 2025
We identified it
Jun 21, 2026
Summary
KMAP updated their high dollar rare disease drug list for Q4 2025, eliminating the separate handling fee effective November 1, 2025. These drugs must now be billed as outpatient claims by facilities (not inpatient) and still require prior authorization with purchasing invoices, but without additional payment for handling services.
Action Required
Before November 1, 2025: Billing team must update procedures to eliminate handling fee billing for high dollar rare disease drugs (Abecma, Amondys 45, Breyanzi, Carvykti, Exondys 51, Givlaari, Kymriah, Luxturna, Soliris). Ensure these drugs are billed as outpatient claims only, never on inpatient claims. Continue requiring prior authorization and purchasing invoices. Monitor KMAP for upcoming carve-out drug list bulletin.