KMAP BULLETIN: MediKan Drug Coverage Update

Date: 12/06/22

KMAP GENERAL BULLETIN 22296 (PDF)

Effective with dates of service on and after December 1, 2022, drug coverage on the pharmacy benefit for members deemed MediKan eligible will change. Examples of MediKan formulary drugs are included in the table on the following pages. This is a single point in time list and does not specify dosage forms covered versus not covered. This list does not include other impacts to claim coverage, such as drug rebate labeler status.

To determine specific national drug code (NDC) coverage under the MediKan program or examples of MediKan formulary drugs, use the NDC Code Search on the Kansas Medical Assistance Program (KMAP) website here.

Effective with dates of service on and after December 1, 2022, Physician Administered Drugs (PADs), will not be covered under the MediKan program. 

The only exceptions to the new MediKan coverage rules are for current MediKan members who are receiving two or more routinely used drugs that will no longer be covered under the MediKan program, such as lisinopril, naproxen, and losartan. These drugs will be grandfathered for those members through November 30, 2023, or until MediKan eligibility ends. Following that time, the non-MediKan formulary drugs will no longer be covered. 

Note: The effective date of the policy is December 1, 2022. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.