Advanced Medical Hold Manual Review


New-to-market medications for Kansas Medicaid beneficiaries may be subject to Advanced Medical Hold Manual Review (AMHMR). Previously, new-to-market medications required clinical approval based upon package insert guidelines for coverage determination on a case-by-case basis. Effective December 1, 2018, new-to-market drugs may require a drug use review based upon the Advanced Medical Hold Manual Review (AMHMR) criteria that were approved by the Drug Utilization Review (DUR) Board in October 2018 and revised on April 10, 2019. An AMHMR PA may be in effect from the time the drug is placed on AMHRM until its review by the Kansas Medicaid DUR Board, at which time formal permanent PA criteria will be established.

To ascertain whether a new drug requires Advanced Medical Hold Manual Review, please review the list of drugs in the following link: http://www.kdheks.gov/hcf/pharmacy/medication_hold_review.htm