Pharmacy
At Sunflower Health Plan, we are committed to providing appropriate, high-quality and cost-effective drug therapy to all Sunflower members. With our partners, we provide innovative and tailored pharmacy solutions, improving member health outcomes by ensuring access to essential medications, cost effective treatments and personalized clinical programs.
Our Pharmacy program uses a large network to give members access to many types of pharmacies, including retail, mail-order and specialty pharmacies. This makes it easy for members to get their medications. We work closely with our pharmacy programs to make sure the needs of our Sunflower members are met.
Sunflower Health Plan covers certain prescription drugs and over-the-counter drugs when prescribed by Sunflower providers. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.
Only drugs that are part of the listed therapeutic classes are affected by the Preferred Drug List (PDL). Therapeutic classes not listed are not part of the PDL and will continue to be covered as they always have for the Kansas Medical Assistance Pharmacy Program.
Some drugs will need prior approval before the medication can be filled at the pharmacy. These drugs are on the prior approval list.
Medication Requests
Choose the appropriate medication request form below:
KanCare Medication Request Forms
- Drug Class and Drug-Specific PA Forms (PDF) - Forms designed to include drug-specific prior authorization criteria.
- Universal/General PA Form (PDF) - Generic form that can be used for any drug prior authorization request. Please review drug criteria and complete form with relevant information.
90-Day Maintenance Drug List
Some drugs for long-term conditions will need to be filled every 90 days starting July 1, 2016. Please visit the KanCare website for a full list of 90-day maintenance drugs (PDF).
K-TRACS Pharmancy Reporting and Annual Attestation
Medicaid providers must check the Kansas Prescription Drug Monitoring Program (called K-TRACS) for an enrollee’s prescription history before prescribing controlled substances to a Medicaid beneficiary or member. See the Sunflower bulletin dated September 6, 2024, for complete details.
Opioid Electronic Prescribing (E-Prescribing)
Since July 2021, Kansas law (K.S.A. § 65-16,128) requires electronic prescribing for schedule II-V controlled substances that contain an opiate unless there is an exception allowed by statue.
For certain exceptions, prescribers may be required apply for a waiver with the Board of Pharmacy. Please see detailed waiver information. If you have a waiver, the written opioid prescription must indicate you have a waiver.
Sunflower Health Plan partners with CoverMyMeds for electronic prior authorization requests.
CoverMyMeds streamlines the medication PA process and provides a fast and efficient way to complete PA requests online. Benefits of using CoverMyMeds include:
- Elimination of telephone calls and faxes, saving up to 15 minutes per PA request.
- Renew previously submitted PA requests.
- Complete pharmacy-initiated requests electronically.
- Secure and Health Insurance Portability and Accountability Act (HIPAA) compliant.
Contact CoverMyMeds at 1-866-452-5017, Monday through Friday, 7:00 a.m. to 10:00 p.m. CT, and from 7:00 a.m. to 5:00 p.m. CT on Saturday. Visit CoverMyMeds to sign up or request an authorization.
Important Pharmacy Benefit Manager Change, Effective January 1, 2024
We are pleased to announce that, effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for our plan members for KanCare (Medicaid), Wellcare (Medicare) and Ambetter (Marketplace). Learn more.
New-to-Market Drugs Requiring Prior Authorization
New-to-market medications for Kansas Medicaid beneficiaries may be subject to Advanced Medical Hold Manual Review (AMHMR). Please refer to the KDHE website for detailed information regarding clinical prior authorization criteria.
Contact the Pharmacy Solutions Customer Service Center at (800) 460-8988 if you have questions about member eligibility, joining the pharmacy network or Sunflower pharmacy reimbursements.