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Pharmacy prior authorization (PA)

When a covered medication requires PA, you can request pharmacy prior authorization. You can enroll in our electronic prior authorization (ePA) program by registering with either CoverMyMeds® or Surescripts.

 

CoverMyMeds  Surescripts

 

Learn more

Provider manual (PDF)

 

Or call Provider Experience at 1-855-221-5656 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.

Pharmacy PA guidelines

Pharmacy PA guidelines

We follow the KanCare (Medicaid) clinical criteria for our pharmacy PA decisions. If you’d like us to mail you a copy of these guidelines, just call us at 1-855-221-5656 (TTY: 711).

Electronic PA

Electronic PA

You need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request a pharmacy PA with our ePA program. 

 

With ePA, you can look forward to saving time with:

 

  • Less paperwork 

  • Fewer phone calls and faxes

  • Quicker determinations 

  • Safe and secure HIPAA-compliant submitted requests

  • Easy upload of clinical documents

Enroll now


Getting started with ePA is free and easy. You’ll just need this plan information to enroll:
 

If Aetna Better Health® is the member’s primary plan:
BIN#:     610591

PCN:      ADV

GRP:      RX8849
 

If Medicare Part B or Part D is the member’s primary plan:

BIN#:     012114

PCN:      COBADV

GRP:      RX8849
 

If member’s primary plan is a commercial plan:

BIN#:     013089

PCN:      COMSEGADV

GRP:      RX8849 
 

You can enroll two different ways:

CoverMyMeds

You can enroll with CoverMyMeds online. Or call 1-866-452-5017.

Surescripts

You can enroll with Surescripts online.
Or call 1-866-797-3239.

Other ways to request PA

 

If you don’t want to enroll in ePA, you can request PA:

By phone

Call us at 1-855-221-5656 (TTY: 711).

By fax

You can fax your request to us at 1-844-807-8453. Be sure to include all documentation needed for us to complete the medical necessity review.

PA request forms

To see which drugs need PA, just use this Clinical Prior Authorization Index (PDF). From there, you can find more information about the medication, including clinical criteria and individual PA request forms.  

 

Non-preferred drug list: To see which non-preferred drugs need PA, just use this preferred and non-preferred drug list (PDF). You can also learn more about clinical criteria (PDF) or find the non-preferred PDL PA request form (PDF). 

Learn more about PA

 

Pharmacy PA

Non-pharmacy PA

CoverMyMeds is a registered trademark of CoverMyMeds LLC.

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