MedicaidPrior AuthHigh impact
KMAP BULLETIN: Pharmaceutical Prior Authorization Updates – June 2026
Kansas Medicaid (KanCare)·KS · Allergy & Immunology, Endocrinology, Dermatology +4 more·Provider Bulletin
Effective date
Jun 30, 2026
We identified it
Jul 17, 2026
Summary
KMAP is updating pharmaceutical prior authorization requirements effective June 30 - July 1, 2026. Omalizumab (Xolair®) will no longer require PDL prior authorization, while Bosutinib (Bosulif®), Semaglutide (Ozempic®), Bimatoprost (Zolymbus™), Clonidine 0.05mg, Gabapentin (Relgaabi® 200mg), and Tolmetin sodium 200mg will have new or changed prior authorization requirements. MCO implementation dates may vary.
Action Required
By June 30, 2026: Billing team must update pharmacy billing system and prior authorization workflows. (1) REMOVE PDL PA requirement for Omalizumab (Xolair®) effective June 30, 2026. (2) ADD Clinical PA requirement for Bosutinib (Bosulif®) and Semaglutide (Ozempic®) effective July 1, 2026. (3) ADD PDL PA requirement for Bimatoprost (Zolymbus™), Clonidine 0.05mg tablet, Gabapentin (Relgaabi® 200mg), and Tolmetin sodium 200mg tablet effective July 1, 2026. Update prior authorization submission templates and provider order entry systems to reflect new requirements. Coordinate with all KanCare MCOs to confirm their individual system implementation dates using the KanCare Open Claims Resolution Log on the KMAP Bulletins page. Train billing and prior auth staff on medication-specific requirements. Failure to implement correct prior authorization rules will result in claim denials and delays.