For KanCare pharmacy network contracting questions, please contact: email@example.com.
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by KanCare. Click on the link below to view the Preferred Drug List.
KanCare now offers a Universal Pharmacy / Medical Prior Authorization Form to simplify the prior authorization process by combining both the health plan and Fee-For-Service forms.
All forms for all drugs requiring prior approval for all KanCare members are located on the Kansas Department of Health and Environment website.
The universal form can be used for any drug prior authorization request. It’s important to review drug criteria and complete the form with all relevant information. If required information in the specific drug criteria is not included in the prior authorization request, the request may be denied for lack of information.
All contact information for all KanCare health plans and Fee-For-Service Pharmacy and Medical Prior Authorization Departments can be found on the form.
Fax completed forms to the Pharmacy or Medical Prior Authorization department based on where the drugs are being billed and dispensed:
KDHE Prior Authorization Criteria
Coordination of Benefits Billing Instructions (PDF 47.25 KB)
Quantity Limit Policy (PDF 20.96 KB)
Re-Review / Reconsideration Prior Authorization Request Form (PDF 95.03 KB)
UnitedHealthcare KanCare Pharmacy Contact List (PDF 263.25 KB)
UnitedHealthcare Flu Vaccine Information for 2015-2016 (PDF 86.08 KB)
For dates of service on and after Jan. 1, 2017, the Medicare Part D Copayment assistance amount will be $8.25 per 30-day supply with a maximum of up to $24.75 for a 90-day supply.
Prior authorization is required for some medications.
Dose Optimization Program (PDF 62.25 KB)
Changes Effective Jan. 1, 2016
Effective Jan. 1, 2016, only LifeScan (OneTouch®) meters and test strips will continue to be preferred on the Preferred Drug List. The LifeScan meters will be offered at no cost for members. The other manufacturers of tests strips, including Roche (Accu-Chek®), will be removed from the Preferred Drug List and become non-preferred.
Non-Preferred Testing Supplies as of
January 1, 2016
Preferred Testing Supplies as of
January 1, 2016
Accu-Chek Test Strips:
One-Touch Test Strips:
Please encourage your patients to use the preferred products and provide them with a new prescription for these products. If the preferred alternative testing supplies are not appropriate for your patients, they may still obtain the non-preferred brand through a DME provider and you will not need to do anything different to keep your patient on the non-preferred product.
If you have questions, please call Provider Services at 877-542-9235, Monday – Friday, 8 a.m. to 8 p.m. (CT). Thank you.
UnitedHealthcare Community Plan works with OptumRx to manage the Pharmacy network. Multiple sources are used by OptumRx in order to assure the Maximum Allowable Cost (MAC) list accurately reflects market pricing and availability of generic drugs. Sources include de-identified market pricing, benchmark data including Average Wholesale Price (AWP) and Wholesaler Acquisition Cost (WAC), wholesaler information on market availability, and individual pharmacy feedback.
The synthesis of this information helps create a market based MAC price for generic items included on the MAC list. These sources are monitored and updates are used to help manage the market fluctuations of pricing on the MAC list.
The MAC lists are reviewed on a monthly basis.
For Kansas Medicaid MAC inquiries, please contact OptumRx through email at firstname.lastname@example.org. For general
contract information, please contact OptumRx at 1-800-613-3591 option 7 or through email at
A contracted pharmacy may access MAC prices here: https://professionals.optumrx.com/landing/kansas.html
Pharmacies with specific claim related questions should contact OptumRx at 1-877-305-8952, Available 24 hours daily, 7 days a week.
MAC Appeal Form (PDF 271.25 KB)