Updated July 27, 2023
A Kansas Medicaid prior authorization form allows a medical professional to request coverage for a drug that is not on the Preferred Drug List (PDL) on behalf of a patient who is a Medicaid member. You will need to justify your request and explain why you are not prescribing medication from the PDL. Once the form is complete, it will need to be faxed to the appropriate directory. Be sure to attach any relevant supporting medical documents along with your submission. A fillable PDF version of the Kansas Medicaid prior authorization form can be found on this page.
Preferred Drug List (PDL) – List of pre-approved drugs by the State