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 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.

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.

Preferred Drug List

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

• Which medications are covered, including both brand and generic names;
• What tier each medication is on

Provider Support from Pharmacy Solutions

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.

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 CoverMyMeds to sign up or request an authorization.

Kansas PA Criteria

• Prior Authorization - Clinical Criteria
• Prior Authorization - Non-Preferred PDL PA

Pharmacy Forms

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).

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.