Pharmacy Information

Document Resources

FileTypeSizeUploaded onDownload
Prefered Drug List 5-3-17PDF553.59 KB08 May, 2017 Download
General Pharmacy GoLive GuidePDF214.83 KB16 Nov, 2016 Download
KanCare MCO Billing Reference SheetPDF139.29 KB16 Nov, 2016 Download
90-Day Maintenance Medication ListPDF230.78 KB16 Nov, 2016 Download

NDC Coverage Lookup

Use the KMAP Secure Web portal to verify the member’s benefit plan. When using the NDC Search Tool, use either TXIX or the ADAP benefit plan to query general KanCare coverage. Pricing information and limitations on this website may not be applicable to the KanCare health plans. Information provided does not guarantee coverage or payment, as these are based on the beneficiary’s eligibility or other restrictions.

Grievances and Appeals

Drug Utilization Review (DUR) Program

The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) required each state Medicaid Program to establish a Drug Utilization Review (DUR) program for outpatient drugs. The DUR program provides education to physicians, mid-level practitioners and pharmacists. This education is provided through patient profile reviews, population-based interventions, academic detailing visits and a quarterly newsletter.

By Kansas law, the DUR Board is composed of four physicians, four pharmacists and one Advanced Registered Nurse Practitioner (ARNP) or Physician’s Assistant (PA). Each appointment is for three years. The Board is responsible for implementing and operating the DUR Program and making recommendations to DHCF regarding drug therapy issues. The DUR Board meets quarterly, the second Wednesday of the month. All meetings are held in accordance with K.S.A. 75-4319 (Kansas Open Meetings Act).

Please visit the KDHE web page for additional DUR information.

Program Contacts:
Annette Grant, RPh
Division of Health Care Finance
Pharmacy Program Manager
Annette.Grant@kdheks.gov
Ariane Casey, Pharm.D.
Clinical Pharmacist
Health Information Designs
Ariane.Casey@hidesigns.com

MCO Pharmacy Policies

Visit the KDHE pharmacy page for more information.