CommercialPrior AuthMedium impact
Pharmacy Medical Policy Updates
Blue Cross Blue Shield of Kansas·KS · Oncology, Endocrinology, Rheumatology +3 more·Pharmacy
Effective date
Jan 15, 2023
We identified it
Jun 19, 2026
Summary
BCBS Kansas updated multiple pharmacy medical policies effective January 15, 2023 and February 1, 2023, affecting biologic immunomodulators, ACA copay waivers, and several other medication categories. These policies are managed through Prime Therapeutics and may require prior authorization changes for affected medications.
Action Required
By January 15, 2023: Billing team must review updated pharmacy policies for Biologic Immunomodulators on BCBS Kansas website at https://www.bcbsks.com/providers/precertification-prior-authorization. By February 1, 2023: Review additional policy updates for ACA Copay Waiver, Natpara, Retinoids, Antidepressants, Urea Cycle Disorders, Factor VIII and VWF, Isturisa SA, and Oncology Coverage Exception programs. Contact BCBSKS provider representative for specific prior authorization requirements as these may affect claim processing.