MedicaidPrior AuthHigh impact
KMAP BULLETIN: Pharmaceutical Prior Authorization – August 2025 Updates
Kansas Medicaid (KanCare)·KS · Endocrinology, Oncology, Rheumatology +4 more·Provider Bulletin
Effective date
Aug 1, 2025
We identified it
Jun 21, 2026
Summary
KMAP requires new prior authorization for multiple medications effective August 1, 2025 (Preferred Drug List PA) and September 16, 2025 (Clinical PA). This affects prescription billing and requires obtaining authorization before prescribing covered medications to avoid claim denials.
Action Required
By August 1, 2025: Update billing system and provider workflows to require Preferred Drug List PA for 8 medications including Ryzneuta, Khindivi, Merilog, Xifyrm, Brynovin, and Xphozah. By September 16, 2025: Implement Clinical PA requirements for 18 additional medications including Avmapki, Daxxify, Jubbonti, Opdivo Qvantig, and others. Providers must obtain authorization before prescribing. Update EMR alerts and pharmacy benefit verification processes. Claims will be denied without proper authorization.