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MedicaidPrior AuthMedium impact

KMAP BULLETIN: Pharmaceutical Prior Authorization Updates – April 2025

Kansas Medicaid (KanCare)·KS·Provider Bulletin
Effective date
Apr 1, 2025
We identified it
Jun 21, 2026
Days to comply

Summary

KMAP updated their Preferred Drug List prior authorization requirements effective March 31-April 1, 2025. Four medications now require prior authorization (including clobetasol cream, metaxalone, metformin IR, and Alyftrek), while six medications no longer require prior authorization (including Ebglyss, Lyfgenia, Xtampza ER, and Nucynta products).

Action Required

Action needed
By April 1, 2025: Update prior authorization protocols for clobetasol propionate 0.025% cream, metaxalone 640 mg, metformin 750mg IR, and Alyftrek (vanzacaftor/tezacaftor/deutivacaftor). Remove prior authorization requirements for Ebglyss, Lyfgenia, Xtampza ER, Nucynta, Nucynta ER, and Anoro Ellipta as of March 31, 2025. Pharmacy and clinical staff must update medication ordering systems and verify MCO implementation status via KanCare Open Claims Resolution Log.