General Clinical Prior

Authorization (PA)

Medications requiring Clinical Prior Authorization (PA) for Kansas Medicaid are listed in the link below. Please use this table to identify if a specific medication requires Clinical PA and which Clinical PA criteria and PA form should be used to request an authorization from the patient’s specific health plan (MCO/FFS). Please note, medications requiring Clinical PA may also have to meet Non-preferred PDL PA criteria before the claim may be considered for payment and this will be designated on the PA form. Products listed in red font have criteria updated since the last posting. For drugs that are new to the market and not listed in the table, please click the following medication hold link for further information:

To search a drug by drug name please click the TABLE OF CONTENTS.

Click here to search Disease State/Drug Class PA Criteria.