To view the most accurate list of requirements and submit a formal request on behalf of your patient, use the button below. A Blue KC provider portal account is required to submit, review, and manage authorization requests. We’ve also provided generalized lists of requirements organized by plan type, but please note that these requirements vary by patient.
Review or Submit Prior AuthorizationsBlue KC Provider Portal for Prior Authorization Requests will be offline from January 11th at 2:00 p.m. to January 11th at 11:00 p.m.
Blue KC Prior Authorization and Notification List
The following medications or classes of medications require prior authorization. Medications may appear more than once. Please verify you are using the correct list (Medical vs. Pharmacy benefit) when researching any given medication.
Commercial Medications
Commercial / Employer Groups & JAA include all prefixes excluding those explicitly listed for the other plan types below.
ACA Medications
Affordable Care Act (ACA) prefixes include YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ, or YJT.
FEP Medications
Federal Employee Plan (FEP) member ID numbers begin with the letter R and do not include a prefix.
- FEP Pharmacy Benefit - available through the fepblue.org website.
Additional Information
Quantity Limits
A quantity limit refers to the amount of drug needed to take the daily dose, according to the recommendations of the U.S. Food and Drug Administration (FDA). Quantity limits promote safe, cost-effective drug use and reduce waste and overuse. These limits are designed to control the use of selected drugs for quality and safety reasons. Prior authoriztion is required if / when a patient requires use beyond the quantity limit. The following list is subject to change and does not guarantee coverage.
New Medications & Changes to Requirements
All new-to-market medications will require a Prior Authorization. If the medication is a new-to-market drug or is not listed, please submit a Prior Authorization request. As new products are released and post-marketing information on existing therapies becomes available, changes to our lists may occur.
Name Brand Medications with an available Generic
Name brand medications with an available generic require the use of that generic option. If there is a clinical reason the patient cannot use the generic, it requires Prior Authorization.
Code Exceptions
Codes J3490, J3590, J9999 and C9399 do not require PA for all drugs associated with them. Those that do require prior authorization are listed by name in the documents above.
If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance.
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