MedicaidPrior AuthHigh impact
KMAP BULLETIN: Pharmaceutical Prior Authorization Updates
Kansas Medicaid (KanCare)·KS · Rheumatology, Oncology, Pulmonology +6 more·Provider Bulletin
Effective date
Oct 14, 2024
We identified it
Jun 21, 2026
Summary
Effective October 14, 2024, Kansas Medicaid (KanCare) added prior authorization requirements for 18 new medications including adalimumab, tocilizumab, and other specialty drugs, while removing prior auth for infigratinib. A grandfather process protects current patients with 80% adherence on maintenance medications.
Action Required
Immediately: Update prior authorization workflows to require clinical PA for the 18 newly listed medications before prescribing or billing. Pharmacy and billing teams must verify PA status for adalimumab-ryvk, tocilizumab variants, upadacitinib oral solution, and other specified drugs. Remove PA requirements for infigratinib (Truseltiq). Claims will be denied without proper prior authorization.