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Learn more
Or call Provider Experience at 1-855-221-5656 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.
Pharmacy PA guidelines
Pharmacy PA guidelines
We follow the KanCare (Medicaid) clinical criteria for our pharmacy PA decisions. If you’d like us to mail you a copy of these guidelines, just call us at 1-855-221-5656 (TTY: 711).
Electronic PA
Electronic PA
You need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request a pharmacy PA with our ePA program.
With ePA, you can look forward to saving time with:
Less paperwork
Fewer phone calls and faxes
Quicker determinations
Safe and secure HIPAA-compliant submitted requests
Easy upload of clinical documents
Enroll now
Getting started with ePA is free and easy. You’ll just need this plan information to enroll:
If Aetna Better Health® is the member’s primary plan:
BIN#: 610591
PCN: ADV
GRP: RX8849
If Medicare Part B or Part D is the member’s primary plan:
BIN#: 012114
PCN: COBADV
GRP: RX8849
If member’s primary plan is a commercial plan:
BIN#: 013089
PCN: COMSEGADV
GRP: RX8849
You can enroll two different ways:
Other ways to request PA
If you don’t want to enroll in ePA, you can request PA:
By phone
Call us at 1-855-221-5656 (TTY: 711).
By fax
You can fax your request to us at 1-844-807-8453. Be sure to include all documentation needed for us to complete the medical necessity review.
PA request forms
To see which drugs need PA, just use this Clinical Prior Authorization Index (PDF). From there, you can find more information about the medication, including clinical criteria and individual PA request forms.
Non-preferred drug list: To see which non-preferred drugs need PA, just use this preferred and non-preferred drug list (PDF). You can also learn more about clinical criteria (PDF) or find the non-preferred PDL PA request form (PDF).
CoverMyMeds is a registered trademark of CoverMyMeds LLC.