MedicaidPrior AuthMedium impact
KMAP BULLETIN: Prior Authorization Updates
Kansas Medicaid (KanCare)·KS · Oncology, Psychiatry, Internal Medicine +1 more·Provider Bulletin
Effective date
Jun 1, 2024
We identified it
Jun 21, 2026
Summary
Kansas Medicaid (KanCare) now requires prior authorization for Pegfilgrastim-cbqv (Udenyca® OnBody) PFS and Venlafaxine besylate ER tablets effective June 1, 2024. Patients currently taking these medications with 80% adherence will receive automatic grandfather approval, but new patients will need prior authorization.
Action Required
Immediately: Billing team must update prior authorization requirements for Pegfilgrastim-cbqv (Udenyca® OnBody) PFS and Venlafaxine besylate ER tablets for KanCare patients. Verify patient adherence rates (80% threshold) to determine grandfather PA eligibility. Check KDHE website for Clinical PA criteria before submitting claims. Monitor KanCare MCO implementation status on KMAP Bulletins page as timing may vary by plan.