Pharmacy

Sunflower Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Sunflower members. Sunflower covers prescription medications and certain over-the-counter medications with a written order from a Sunflower Health Plan provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.

Use the KanCare Preferred Drug List to find more information on the drugs that are covered.

Provider Support from Envolve Pharmacy Solutions

Contact the Envolve Pharmacy Solutions Customer Service Center at (800) 460-8988 if you have questions about member eligibility, joining the pharmacy network or Sunflower pharmacy reimbursements.

CoverMyMeds

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 www.covermymeds.com to sign up or visit www.covermymeds.com/epa/envolverx to request an authoriztion.

Kansas PA Criteria

• Prior Authorization - Clinical Criteria
• Prior Authorization – Non-Preferred PDL PA (PDF)

Pharmacy Forms

Medication Requests

Choose the appropriate medication request form below:

KanCare Medication Request Forms

• Drug-Specific PA Forms - Forms designed to include drug-specific prior authorization criteria.
• Universal/General PA Forms - Generic forms that can be used for any drug prior authorization request. Please review drug criteria and complete form with relevant information.
• Class-Specific PA Forms

Buy and Bill Medication Request Form

• Biopharmacy Medication Request Form (PDF) - Biopharmaceutical medication requests will go through Sunflower. To submit a request for medications that will be administered by a provider (i.e. biopharmacy, home health, outpatient, injectable or infusible medications), use this form.
• Synagis PA Form (PDF)

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.

Adherence Packaging Request Form (PDF) - Related to 90-day maintenance medication supplies.

Zika Prevention – Insect Repellent Coverage

Select insect repellents are available through the Envolve Pharmacy Solutions/Sunflower pharmacy benefit. Coverage requires a prescription and is limited to one insect repellent per fill and two fills per month. Covered products include Ultrathon 56.7gm, 170 gm and Off Deep Woods 25% spray.

New Drugs Requiring Prior Authorization

Please refer to the KDHE website for detailed information regarding clinical prior authorization criteria.