FAQ's

Pharmacy Frequently Asked Questions

A formulary is a list of drugs that a health plan covers. The Preferred Drug List is a list of preferred drugs on the formulary.  These drugs treat a variety of illnesses. We keep up to date on changes in drugs.

The Kansas Medical Assistance Program (KMAP) uses a group of providers and pharmacists (Preferred Drug List (PDL) Committee) to make these choices. After a review, the committee may add or remove drugs to the list.

Providers try to write for drugs on the drug list. Sometimes they write for drugs not on the list. Your provider may have forgotten which drugs are on your plan list. Providers may write for new drugs after a visit from a drug company representative. They may write for new drugs after seeing an ad.  Some providers may write for drugs that they have used for a long time although different drugs may be on the drug list. You can find updated lists on this website and in our member newsletter.

Your provider may write for any drug. Your provider can request a change from the drug list. Your provider must show that a drug not on the list is necessary to treat you in order for the drug to be covered. 

A drug that is used to treat a specific disease which requires special handling and care support.

A Pharmacy that does the special handling and care support for Specialty drugs. This type of pharmacy can offer services to members to help support their complex diseases. The Specialty Pharmacy will provide the following:

  • Support of practitioners/providers who specialize in specific complex disease, any time day or night.
  • Emergency pharmacist consultations available 24 hours a day, seven days a week.
  • Special handling and delivery of injectable, infused and select oral medications.

Your prescription can be delivered to many locations including: your home, your provider office or any pharmacy in the network for pick up.

Call CVS Caremark Specialty at 1-800-237-2767, they will work with you to make sure you do not go without your medication.

Some drugs require preapproval by your provider. Your provider will know how to do this.

Drug coverage is determined by KMAP and certain requirements must be met first prior to approval. Call Member Services at our toll-free number 1-855-221-5656, (TTY: 711).

Quantity limits are set on drugs for different reasons. Limits are set because some drugs have a maximum limit or a maximum dose.

The limits are reviewed and set by clinical staff. 

Your provider can contact us so our pharmacy staff can review the medical information provided by your provider and decide if they will make an exception.

The following drugs are not covered under the formulary:

  • Medications for cosmetic use
  • Hair growth agents
  • Drugs to treat infertility
  • Experimental or investigational medications
  • Most over-the-counter drugs, except those listed on the formulary
  • Brands that have a generic substitute
  • Symptomatic relief of cough and cold products
  • Drugs used for weight loss (with the exception of those requiring prior authorization) or weight gain