For KanCare pharmacy network contracting questions, please contact: firstname.lastname@example.org.
Coordination of Benefits Billing Instructions (PDF 47.25 KB)
Prior Authorization Form (PDF 66.82 KB)
Quantity Limit Policy (PDF 20.96 KB)
Re-Review / Reconsideration Prior Authorization Request Form (PDF 95.03 KB)
UHC KanCare Pharmacy Contact List (PDF 263.25 KB)
UHC Flu Vaccine Information 2015-16 (PDF 86.08 KB)
90 Day Maintenance Medication List (PDF 231.66 KB)
The Kansas Department of Health and Environment will require a mandatory 90-day fill policy to be implemented for maintenance medications for all KanCare managed care beneficiaries.
Requirements for prescriptions that should be converted to 90-day supplies are as follows:
Patients receiving prescription medications covered under this policy will be notified of the new requirement for the 90 day supply.
The following populations will be excluded from the 90-day fill requirement:
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.
Drugs Requiring Prior Authorization as of 6/10/2015
Please refer to the KDHE Pharmacy website, using the link below, for clinical prior authorizations criteria: http://www.kdheks.gov/hcf/pharmacy/pa_criteria.htm
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 Aviva Plus
· Accu-Chek Aviva Connect
· Accu-Chek Aviva Expert
· Accu-Chek Compact Plus
· OneTouch UltraMini Meter
· OneTouch Ultra 2 Meter
· OneTouch Verio Meter
· OneTouch Verio IQ Meter
· OneTouch Verio Sync Meter
Accu-Chek Test Strips:
· Accu-Chek Aviva Plus Test Strips
· Accu-Chek SmartView Test Strips
· Accu-Chek Compact Test Strips
· Accu-Chek Comfort Test Strips
· Accu-Chek Active Test Strips
One-Touch Test Strips:
· OneTouch Ultra Test Strips
· OneTouch Verio 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 email@example.com. 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)