Helpful Resources
For additional guidance with electronic prior authorization, download a prior authorization checklist for
Medical Services or
Medications.
Online Requests for Prior Authorization Require a Blue KC Account
A Blue KC Provider Portal account is required to view and submit online requests. If you don't know your username and password, participating providers should work with their organization's administrator for this portal. If you need assistance identifying this person in your organization, please contact your Blue KC Account Executive. For username or password help with an existing account, call the Blue KC provider hotline at 816-395-3700.
If you don't have a username and password, please register now.
Review the Status of an Existing Request
Review existing requests below or by calling the customer service number listed on the member ID card:
Which services and medications require prior authorization?
This page provides a list of services and medications that may require prior authorization. Use this page to help
identify if you should request a prior authorization for a certain service or medication. If you see a service or
medication listed below, get started and submit a new request below.
Services and medications listed are subject to change. You may also request a prior authorization for a service or
medication that is not listed.
Use the Member ID card to identify the Member's plan type: Medicare Advantage member prefixes RKC, RKQ, RRK, or RRN Affordable Care Act member prefixes YBD, YBG, YBS, YBM, YBT, YPX, YJV, YJW, YJJ, or YJT
All other prefixes not listed above correspond to Commercial, FEP, and/or JAA
These services, Durable Medical Equipment (DME) and Prostheses or such equipment require a prior authorization.
Services & Procedures That Require Prior Authorization
Services & Procedures for Members in Affordable Care Act Plans
You may also submit requests by fax or mail. Please include any supporting medical information in your request. Check the status of an existing request using the customer service number listed on the member ID card.
Fax Requests for Commercial Plan Members
816-926-4253
Mail-in Requests for Commercial Plan Members
Blue Cross and Blue Shield of Kansas City
Attention: Prior Authorization, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878
Fax Requests for ACA and Medical Advantage Plan Members
877-549-1744
Mail-in Requests for ACA and Medicare Advantage Plan Members
Central Operations (COPS) Blue KC MA & ACA
P.O. Box 419169
Kansas City, MO 64141
The member ID for someone in an Individual and Family ACA Plan will begin with one of the following
prefixes:
YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ or YJT
The member ID for a Medicare Advantage member will begin with a prefix of RRK or RKN.
These medications are covered under the member's medical plan benefits and require prior authorization. This includes Medical Advantage Part B medications.
Medications That Require Prior Authorization
Medications for Members in Commercial Plans (includes FEP & JAA)
Respiratory Syncytial Virus Immune Globulin
Lutetium Lu 177 Dotatate Therapeutic 1 Mci
Abatacept Injection
Injection Agalsidase Beta 1 Mg
Injection Alemtuzumab 1 Mg
Lumizyme Injection
Alpha 1 Proteinase Inhibitor
Glassia Injection
Belimumab Injection
Injection Cerliponase Alfa 1 Mg
Injection Lanadelumab-Flyo 1 Mg
Inj C1 Esterase Inhib Ruconest 10 U
C-1 Esterase Berinert
C-1 Esterase Cinryze
Injection C-1 Esterase Inhibitor 10 Units
Injection Etelcalcetide 0.1 Mg
Canakinumab Injection
Collagenase Clost Hist Inj
Inj Corticotropin To 40 Units
Denosumab Injection
Ecallantide Injection
Eculizumab Injection
Injection Edaravone 1 Mg
Elosulfase Alfa Injection
Inj Epoprostenol 0.5 Mg
Inj Ivig Privigen 500 Mg
Inj Gamma Globulin Im 1 Cc
Injection Immune Globulin 100 Mg
Inj Imm Glob Bivigam 500Mg
Gammaplex Injection
Hizentra Injection
Inj Gamma Globulin Im Over 10 Cc
Gamunex-C/Gammaked
Immune Globulin Powder
Octagam Injection
Gammagard Liquid Injection
Flebogamma Injection
Inj Ig/Hyaluronidase 100 Mg Ig
Ivig Non-Lyophilized Nos
Golimumab For Iv Use 1Mg
Idursulfase Injection
Inj Infliximab Excl Biosimilr 10 Mg
Imuglucerase Injection
Injection Laronidase 0.1 Mg
Injection Mepolizumab 1Mg
Natalizumab Injection
Injection Nusinersen 0.1 Mg
Injection Ocrelizumab 1 Mg
Injection Omalizumab 5 Mg
Pegloticase Injection
Plerixafor Injection
Romiplostim Injection
Injection Romosozumab-Aqqg 1 Mg
Tocilizumab Injection
Injection Treprostinil 1 Mg
Ustekinumab Intravenous Inj 1 Mg
Injection Vedolizumab 1 Mg
Velaglucerase Alfa
Injection Emicizumab-Kxwh 0.5 Mg
Inj Factor X (Human) 1Iu
Injection Human Fibrinogen Concentrate 1 Mg
Injection Human Fibrinogen Conc Nos 1 Mg
Vonvendi Inj 1 Iu Vwf:Rco
Factor Xiii Anti-Hem Factor
Factor Xiii Recomb A-Subunit
Factor Viii Recomb Novoeight
Wilate Injection
Xyntha Inj
Antihemophilic Viii Vwf Comp
Humate-P Inj
Injection Factor Viii Per I.U.
Factor Viia Antihemophilic Factor Recombinant /1 Microgram
Factor Viii (Anti-Hemophilic Factor Human)Per Iu
Factor Viii Recombinant Nos
Factor Ix (Antihemophilic Factor Purified Non-Recombinant) Per I.U.
Factor Ix Complx Per Iu
Factor Ix Recombinant Nos
Antithrombin Iii (Human) Per Iu
Anti-Inhibitor Per I.U.
Hemophilia Clotting Factor Noc
Factor Ix Recombinan Rixubis
Inj Factor Ix Fc Fus Protein Per Iu
Factor Ix Idelvion Inj
Injection Factor Ix Glycopegylated 1 Iu
Inj Factor Viii Fc Fusion Per Iu
Factor Viii Pegylated Recomb
Injection Factor Viii Pegylated-Aucl 1 Iu
Factor Viii Nuwiq Recomb 1Iu
Inj Factor Viii Afstyla 1 I.U.
Inj Factor Viii Kovaltry 1 I.U.
Orthovisc Inj Per Dose
Injection Avelumab 10 Mg
Injection Bevacizumab 10 Mg
Injection Blinatumomab 1 Microgram
Injection Copanlisib 1 Mg
Injection Liposomal 1 Mg Dnr And 2.27 Mg Ca
Injection Durvalumab 10 Mg
Inj Gemtuzumab Ozogamicin 0.1 Mg
Injection Mogamulizumab-Kpkc 1 Mg
Injection Emapalumab-Lzsg 1 Mg
Ipilimumab Injection
Injection Inotuzumab Ozogamicin 0.1 Mg
Injection Tagraxofusp-Erzs 10 Mcg
Injection Pertuzumab 1 Mg
Injection Polatuzumab Vedotin-Piiq 1 Mg
Injection Rituximab 10 Mg And Hyaluronidase
Injection Rituximab 10 Mg
Inj Ado-Trastuzumab Emt 1Mg
Injection Trastuzumab Excludes Biosimilar 10 Mg
Tisagenlecleucel To 600 M Car-Pos Vi T Ce Per Td
Sipleucel-T Auto Cd54+
Injection, Inflectra
Injection Bevacizumab-Awwb Biosimilar 10 Mg
Inj Pegflgrstm-Jmdb Biosimlr 0.5 Mg
Ogivri (Trastuzumab)
Truxima Injection
Kanijnti Injection
Lutetium Lu 177 Dotatate Ther 1 Mci
Givlaari (givosiran)
Inj Ceftriaxone Sodium Per 250 Mg
Adakveo (crizanlizumab)
Vyondys-53 (golodirsen)
Xembify (immune globulin)
Injection Guselkumab 1 Mg
Zolgensma (onasemnogene abeparvoveck-xioi)
Injection Calaspargase Pegol-Mknl 10 Units
Injection Cemiplimab-Rwlc 1 Mg
Unclassified Drugs
Unclassified Biologics
Injection Elotuzumab 1Mg
Medications for Members in Affordable Care Act Plans
Respiratory Syncytial Virus Immune Globulin
Lutetium Lu 177 Dotatate Therapeutic 1 Mci
Abatacept Injection
Injection Agalsidase Beta 1 Mg
Injection Alemtuzumab 1 Mg
Lumizyme Injection
Alpha 1 Proteinase Inhibitor
Glassia Injection
Belimumab Injection
Injection Cerliponase Alfa 1 Mg
Injection Lanadelumab-Flyo 1 Mg
Inj C1 Esterase Inhib Ruconest 10 U
C-1 Esterase Berinert
C-1 Esterase Cinryze
Injection C-1 Esterase Inhibitor 10 Units
Injection Etelcalcetide 0.1 Mg
Canakinumab Injection
Collagenase Clost Hist Inj
Inj Corticotropin To 40 Units
Denosumab Injection
Ecallantide Injection
Eculizumab Injection
Injection Edaravone 1 Mg
Elosulfase Alfa Injection
Inj Epoprostenol 0.5 Mg
Inj Ivig Privigen 500 Mg
Inj Gamma Globulin Im 1 Cc
Injection Immune Globulin 100 Mg
Inj Imm Glob Bivigam 500Mg
Gammaplex Injection
Hizentra Injection
Inj Gamma Globulin Im Over 10 Cc
Gamunex-C/Gammaked
Immune Globulin Powder
Octagam Injection
Gammagard Liquid Injection
Flebogamma Injection
Inj Ig/Hyaluronidase 100 Mg Ig
Ivig Non-Lyophilized Nos
Golimumab For Iv Use 1Mg
Idursulfase Injection
Inj Infliximab Excl Biosimilr 10 Mg
Imuglucerase Injection
Injection Laronidase 0.1 Mg
Injection Mepolizumab 1Mg
Natalizumab Injection
Injection Nusinersen 0.1 Mg
Injection Ocrelizumab 1 Mg
Injection Omalizumab 5 Mg
Pegloticase Injection
Plerixafor Injection
Romiplostim Injection
Injection Romosozumab-Aqqg 1 Mg
Tocilizumab Injection
Injection Treprostinil 1 Mg
Ustekinumab Intravenous Inj 1 Mg
Injection Vedolizumab 1 Mg
Velaglucerase Alfa
Injection Emicizumab-Kxwh 0.5 Mg
Inj Factor X (Human) 1Iu
Injection Human Fibrinogen Concentrate 1 Mg
Injection Human Fibrinogen Conc Nos 1 Mg
Vonvendi Inj 1 Iu Vwf:Rco
Factor Xiii Anti-Hem Factor
Factor Xiii Recomb A-Subunit
Factor Viii Recomb Novoeight
Wilate Injection
Xyntha Inj
Antihemophilic Viii Vwf Comp
Humate-P Inj
Injection Factor Viii Per I.U.
Factor Viia Antihemophilic Factor Recombinant /1 Microgram
Factor Viii (Anti-Hemophilic Factor Human)Per Iu
Factor Viii Recombinant Nos
Factor Ix (Antihemophilic Factor Purified Non-Recombinant) Per I.U.
Factor Ix Complx Per Iu
Factor Ix Recombinant Nos
Antithrombin Iii (Human) Per Iu
Anti-Inhibitor Per I.U.
Hemophilia Clotting Factor Noc
Factor Ix Recombinan Rixubis
Inj Factor Ix Fc Fus Protein Per Iu
Factor Ix Idelvion Inj
Injection Factor Ix Glycopegylated 1 Iu
Inj Factor Viii Fc Fusion Per Iu
Factor Viii Pegylated Recomb
Injection Factor Viii Pegylated-Aucl 1 Iu
Factor Viii Nuwiq Recomb 1Iu
Inj Factor Viii Afstyla 1 I.U.
Inj Factor Viii Kovaltry 1 I.U.
Orthovisc Inj Per Dose
Injection Avelumab 10 Mg
Injection Bevacizumab 10 Mg
Injection Blinatumomab 1 Microgram
Injection Copanlisib 1 Mg
Injection Liposomal 1 Mg Dnr And 2.27 Mg Ca
Injection Durvalumab 10 Mg
Inj Gemtuzumab Ozogamicin 0.1 Mg
Injection Mogamulizumab-Kpkc 1 Mg
Injection Emapalumab-Lzsg 1 Mg
Ipilimumab Injection
Injection Inotuzumab Ozogamicin 0.1 Mg
Injection Tagraxofusp-Erzs 10 Mcg
Injection Pertuzumab 1 Mg
Injection Polatuzumab Vedotin-Piiq 1 Mg
Injection Rituximab 10 Mg And Hyaluronidase
Injection Rituximab 10 Mg
Inj Ado-Trastuzumab Emt 1Mg
Injection Trastuzumab Excludes Biosimilar 10 Mg
Tisagenlecleucel To 600 M Car-Pos Vi T Ce Per Td
Sipleucel-T Auto Cd54+
Injection, Inflectra
Injection Bevacizumab-Awwb Biosimilar 10 Mg
Inj Pegflgrstm-Jmdb Biosimlr 0.5 Mg
Ogivri (Trastuzumab)
Truxima Injection
Kanijnti Injection
Spl Radophrm Tx Imag Agt Noc
Injection, Brexanolone, 1Mg
Kcentra, Per I.U.
Aflibercept Injection
Injection Brolucizumab-Dbll 1 Mg
Alglucosidase Alfa Injection
Injection Patisiran 0.1 Mg
Injection Benralizumab 1 Mg
Injection Bezlotoxumab 10 Mg
Buprenorphine Implant 74.2Mg
Injection Burosumab-Twza 1 Mg
Injection Onabotulinumtoxina
Abobotulinumtoxina
Inj Rimabotulinumtoxinb
Incobotulinumtoxin A
Certolizumab Pegol Inj 1Mg
Injection Darbepoetin Alfa 1 Microgram Non-Esrd Use
Injection Darbepoetin Alfa 1 Microgram For Esrd On Dialysis
Injection Epoetin Alfa For Non-Esrd Use 1000 Units
Epoetin Beta Esrd Use
Epoetin Beta Non Esrd
Injection Ravulizumab-Cwvz 10 Mg
Injection Eteplirsen 10 Mg
Inj Ferric Carboxymaltos 1Mg
Inj Filgrastim Excl Biosimil
Injection Tbo-Filgrastim 1 Microg
Injection Galsulfase 1 Mg
Injection Glatiramer Acetate 20 Mg
Injection Hpc 10 Mg
Injection Hpc Nos 10 Mg
Interferon Beta-1A Inj
Interferon Beta-1B Per 0.25 Mg Admin Phys Superv
Lanreotide Injection
Inj Leuprolide Acetate Per 3.75 Mg
Injection Octreotide Depot Form For Intramuscular Injection
Inj Octreotide Non-Depot Form For Subctns Or Intrvns Inj 25 Mg
Inj Pasireotide Long Acting 1 Mg
Injection Pegaptanib Sodium 0.3 Mg
Injection Pegfilgrastim 6 Mg
Ranibizumab Injection
Injection Rasburicase 0.5 Mg
Injection Reslizumab 1Mg
Inj Sargramostin (Gm-Csf)/50Mcg
Inj Sebelipase Alfa 1 Mg
Inj Taliglucerace Alfa 10 U
Injection Tildrakizumab 1 Mg
Inj Triptorelin Pamoate 3.75 Mg
Injection Triptorelin Extended-Release 3.75 Mg
Inject Vestronidase Alfa-Vjbk 1 Mg
Injection Voretigene Neparvovec-Rzyl 1 B Vec G
Hyaluronan/Derivative Durolane For Ia Inj 1 Mg
Hyaluronan/Derivitive Genvisc 850 Ia Inj 1 Mg
Hyal Hyalgn Supartz/Vsco-3 Ia Inj-D
Hyaluronan/Driv Hymovis Ia Inj 1 Mg
Euflexxa Inj Per Dose
Synvisc Or Synvisc-One
Gel-One
Monovisc Inj Per Dose
Hyal/Deriv Gelsyn-3 Ia Inj 0.1 Mg
Hyaluronan/Derivative Trivisc For Ia Inj 1 Mg
Autol Culturd Chondrocytes Imp
Hyaluronan/Derivative Synojoynt Ia Inj 1 Mg
Hyaluronan/Derivative Triluron Ia Inj 1 Mg
Carbidopa 5 Mg/Levodopa 20 Mg Enteral Suspension, 100 Ml
Treprostinil Non-Comp Unit
Injection Azacitidine 1 Mg
Brentuximab Vedotin Inj
Inj Cladribine Per 1 Mg
Degarelix Injection
Injection Gemcitabine Hcl Nos 200 Mg
Goserelin Acetate Implant Per 3.6 Mg
Leuprolide Acetate For Depot Suspension 7.5 Mg
Vantas Implant
Supprelin La Implant
Inj Omacetaxine Mep 0.01Mg
Pegaspargase Injection
Injection Pembrolizumab 1 Mg
Inj Talimogene Laherparepvec
Injection Trastuzumab 10 Mg And Hyaluronidase-Oysk
Inj Ziv-Aflibercept 1Mg
Not Otherwise Classified Antineoplastic Drugs
Kte-C19 To 200 M A Anti-Cd19 Car Pos T Ce P Td
Inj Beta Interferon Im 1 Mcg
Injection, Zarxio
Injection, Renflexis
Injection Epoetin Alfa-Epbx Biosimilar 1000 U
Herzuma Injection
Inj, Makena
Immune Globulin Human-Iv Use
Human Ig Sc
Botulinum Antitoxin-Equine-Any Route
Injection Cerliponase Alfa 1 Mg
Inj Triptorelin Extend Rel 3.75 Mg
Injection, Elosulfase Alfa
Injection Vedolizumab 1 Mg
Unclassified Drugs Or Biologicals
Injection Pasireotide Long Acting 1 Mg
Injection, Sebelipase Alfa, 1 Mg
Injection, Ocrelizumab, 1 Mg
Injection Epoetin Alfa 1000 Units For Esrd On Dialysis
Inj Filgrastim 300 Mcg
Inj Filgrastim 480 Mcg
Injection Histrelin Acetate 10 Micrograms
Hydroxyprogesterone Caproate
Injection Ibalizumab-Uiyk 10 Mg
Inj Imiglucerase Per Unit
Injection Interferon Beta-1A 33 Mcg
Prescription Drug-Oral-Non-Chemotherapeutic-Nos
Alemtuzumab Injection
Asparaginase Nos
Interferon Alfa-2A Inj
Inj Beta Interferon Sq 1 Mcg
Injection Infliximab-Qbtx Biosimilar 10 Mg
Synagis
Inj Epo 1 Mcg Esrd On Dialysis
Inj Epoetin Beta 1 Mcg Non-Esrd Use
Sildenafil Citrate 25 Mg
Injection Pegylated Interferon Alfa-2A 180 Mcg /Ml
Peg Interferon Alfa-2B/10
Unclassified Drugs
Unclassified Biologics
Medications for Members in Medicare Advantage Plans (Part B)
Respiratory Syncytial Virus Immune Globulin
Lutetium Lu 177 Dotatate Therapeutic 1 Mci
Abatacept Injection
Injection Agalsidase Beta 1 Mg
Injection Alemtuzumab 1 Mg
Lumizyme Injection
Alpha 1 Proteinase Inhibitor
Glassia Injection
Belimumab Injection
Injection Cerliponase Alfa 1 Mg
Injection Lanadelumab-Flyo 1 Mg
Inj C1 Esterase Inhib Ruconest 10 U
C-1 Esterase Berinert
C-1 Esterase Cinryze
Injection C-1 Esterase Inhibitor 10 Units
Injection Etelcalcetide 0.1 Mg
Canakinumab Injection
Collagenase Clost Hist Inj
Inj Corticotropin To 40 Units
Denosumab Injection
Ecallantide Injection
Eculizumab Injection
Injection Edaravone 1 Mg
Elosulfase Alfa Injection
Inj Epoprostenol 0.5 Mg
Inj Ivig Privigen 500 Mg
Inj Gamma Globulin Im 1 Cc
Injection Immune Globulin 100 Mg
Inj Imm Glob Bivigam 500Mg
Gammaplex Injection
Hizentra Injection
Inj Gamma Globulin Im Over 10 Cc
Gamunex-C/Gammaked
Immune Globulin Powder
Octagam Injection
Gammagard Liquid Injection
Flebogamma Injection
Inj Ig/Hyaluronidase 100 Mg Ig
Ivig Non-Lyophilized Nos
Golimumab For Iv Use 1Mg
Idursulfase Injection
Inj Infliximab Excl Biosimilr 10 Mg
Imuglucerase Injection
Injection Laronidase 0.1 Mg
Injection Mepolizumab 1Mg
Natalizumab Injection
Injection Nusinersen 0.1 Mg
Injection Ocrelizumab 1 Mg
Injection Omalizumab 5 Mg
Pegloticase Injection
Plerixafor Injection
Romiplostim Injection
Injection Romosozumab-Aqqg 1 Mg
Tocilizumab Injection
Injection Treprostinil 1 Mg
Ustekinumab Intravenous Inj 1 Mg
Injection Vedolizumab 1 Mg
Velaglucerase Alfa
Injection Emicizumab-Kxwh 0.5 Mg
Inj Factor X (Human) 1Iu
Injection Human Fibrinogen Concentrate 1 Mg
Injection Human Fibrinogen Conc Nos 1 Mg
Vonvendi Inj 1 Iu Vwf:Rco
Factor Xiii Anti-Hem Factor
Factor Xiii Recomb A-Subunit
Factor Viii Recomb Novoeight
Wilate Injection
Xyntha Inj
Antihemophilic Viii Vwf Comp
Humate-P Inj
Injection Factor Viii Per I.U.
Factor Viia Antihemophilic Factor Recombinant /1 Microgram
Factor Viii (Anti-Hemophilic Factor Human)Per Iu
Factor Viii Recombinant Nos
Factor Ix (Antihemophilic Factor Purified Non-Recombinant) Per I.U.
Factor Ix Complx Per Iu
Factor Ix Recombinant Nos
Antithrombin Iii (Human) Per Iu
Anti-Inhibitor Per I.U.
Hemophilia Clotting Factor Noc
Factor Ix Recombinan Rixubis
Inj Factor Ix Fc Fus Protein Per Iu
Factor Ix Idelvion Inj
Injection Factor Ix Glycopegylated 1 Iu
Inj Factor Viii Fc Fusion Per Iu
Factor Viii Pegylated Recomb
Injection Factor Viii Pegylated-Aucl 1 Iu
Factor Viii Nuwiq Recomb 1Iu
Inj Factor Viii Afstyla 1 I.U.
Inj Factor Viii Kovaltry 1 I.U.
Orthovisc Inj Per Dose
Injection Avelumab 10 Mg
Injection Bevacizumab 10 Mg
Injection Blinatumomab 1 Microgram
Injection Copanlisib 1 Mg
Injection Liposomal 1 Mg Dnr And 2.27 Mg Ca
Injection Durvalumab 10 Mg
Inj Gemtuzumab Ozogamicin 0.1 Mg
Injection Mogamulizumab-Kpkc 1 Mg
Injection Emapalumab-Lzsg 1 Mg
Ipilimumab Injection
Injection Inotuzumab Ozogamicin 0.1 Mg
Injection Tagraxofusp-Erzs 10 Mcg
Injection Pertuzumab 1 Mg
Injection Polatuzumab Vedotin-Piiq 1 Mg
Injection Rituximab 10 Mg And Hyaluronidase
Injection Rituximab 10 Mg
Inj Ado-Trastuzumab Emt 1Mg
Injection Trastuzumab Excludes Biosimilar 10 Mg
Tisagenlecleucel To 600 M Car-Pos Vi T Ce Per Td
Sipleucel-T Auto Cd54+
Injection, Inflectra
Injection Bevacizumab-Awwb Biosimilar 10 Mg
Inj Pegflgrstm-Jmdb Biosimlr 0.5 Mg
Ogivri (Trastuzumab)
Truxima Injection
Kanijnti Injection
Spl Radophrm Tx Imag Agt Noc
Injection, Brexanolone, 1Mg
Kcentra, Per I.U.
Aflibercept Injection
Injection Brolucizumab-Dbll 1 Mg
Alglucosidase Alfa Injection
Injection Patisiran 0.1 Mg
Injection Benralizumab 1 Mg
Injection Bezlotoxumab 10 Mg
Buprenorphine Implant 74.2Mg
Injection Burosumab-Twza 1 Mg
Injection Onabotulinumtoxina
Abobotulinumtoxina
Inj Rimabotulinumtoxinb
Incobotulinumtoxin A
Certolizumab Pegol Inj 1Mg
Injection Darbepoetin Alfa 1 Microgram Non-Esrd Use
Injection Darbepoetin Alfa 1 Microgram For Esrd On Dialysis
Injection Epoetin Alfa For Non-Esrd Use 1000 Units
Epoetin Beta Esrd Use
Epoetin Beta Non Esrd
Injection Ravulizumab-Cwvz 10 Mg
Injection Eteplirsen 10 Mg
Inj Ferric Carboxymaltos 1Mg
Inj Filgrastim Excl Biosimil
Injection Tbo-Filgrastim 1 Microg
Injection Galsulfase 1 Mg
Injection Glatiramer Acetate 20 Mg
Injection Hpc 10 Mg
Injection Hpc Nos 10 Mg
Interferon Beta-1A Inj
Interferon Beta-1B Per 0.25 Mg Admin Phys Superv
Lanreotide Injection
Inj Leuprolide Acetate Per 3.75 Mg
Injection Octreotide Depot Form For Intramuscular Injection
Inj Octreotide Non-Depot Form For Subctns Or Intrvns Inj 25 Mg
Inj Pasireotide Long Acting 1 Mg
Injection Pegaptanib Sodium 0.3 Mg
Injection Pegfilgrastim 6 Mg
Ranibizumab Injection
Injection Rasburicase 0.5 Mg
Injection Reslizumab 1Mg
Inj Sargramostin (Gm-Csf)/50Mcg
Inj Sebelipase Alfa 1 Mg
Inj Taliglucerace Alfa 10 U
Injection Tildrakizumab 1 Mg
Inj Triptorelin Pamoate 3.75 Mg
Injection Triptorelin Extended-Release 3.75 Mg
Inject Vestronidase Alfa-Vjbk 1 Mg
Injection Voretigene Neparvovec-Rzyl 1 B Vec G
Hyaluronan/Derivative Durolane For Ia Inj 1 Mg
Hyaluronan/Derivitive Genvisc 850 Ia Inj 1 Mg
Hyal Hyalgn Supartz/Vsco-3 Ia Inj-D
Hyaluronan/Driv Hymovis Ia Inj 1 Mg
Euflexxa Inj Per Dose
Synvisc Or Synvisc-One
Gel-One
Monovisc Inj Per Dose
Hyal/Deriv Gelsyn-3 Ia Inj 0.1 Mg
Hyaluronan/Derivative Trivisc For Ia Inj 1 Mg
Autol Culturd Chondrocytes Imp
Hyaluronan/Derivative Synojoynt Ia Inj 1 Mg
Hyaluronan/Derivative Triluron Ia Inj 1 Mg
Carbidopa 5 Mg/Levodopa 20 Mg Enteral Suspension, 100 Ml
Treprostinil Non-Comp Unit
Injection Azacitidine 1 Mg
Brentuximab Vedotin Inj
Inj Cladribine Per 1 Mg
Degarelix Injection
Injection Gemcitabine Hcl Nos 200 Mg
Goserelin Acetate Implant Per 3.6 Mg
Leuprolide Acetate For Depot Suspension 7.5 Mg
Vantas Implant
Supprelin La Implant
Inj Omacetaxine Mep 0.01Mg
Pegaspargase Injection
Injection Pembrolizumab 1 Mg
Inj Talimogene Laherparepvec
Injection Trastuzumab 10 Mg And Hyaluronidase-Oysk
Inj Ziv-Aflibercept 1Mg
Not Otherwise Classified Antineoplastic Drugs
Kte-C19 To 200 M A Anti-Cd19 Car Pos T Ce P Td
Inj Beta Interferon Im 1 Mcg
Injection, Zarxio
Injection, Renflexis
Injection Epoetin Alfa-Epbx Biosimilar 1000 U
Herzuma Injection
Inj, Makena
Injection Ibandronate Sodium 1 Mg
Injection Atezolizumab 10 Mg
Cabazitaxel Injection
Injection Daratumumab 10 Mg
Injection Nivolumab 1 Mg
Injection Elotuzumab 1Mg
Submitting New Requests
Submit Requests Online, through Blue KC's New Prior Authorization Process
If you see a procedure or code is required, use the get started button on this page to submit a request.
Submit Requests for Commercial, FEP, JAA & Affordable Care Act Members using Legacy Forms
For a period of time, you can still submit new requests using the legacy online process below.
Requests for Commercial, FEP, JAA, ASO and ACA Members Medical Benefit Rx
Submit Requests for Medicare Advantage Members using Legacy Forms
For a period of time, you can submit new requests using the Blue KC online process below.
You may also submit requests by fax or mail. Please include any supporting medical information in your request. Check the status of an existing request using the customer service number listed on the member ID card.
The member ID for someone in an Individual And Family ACA Plan will begin with one of the following prefixes:
YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ or YJT
Fax Requests for Medicare Advantage Plan Members
816-398-6547
Mail-in Requests for Medicare Advantage Plan Members
Central Operations (COPS) BLue KC MA
P.O. Box 419169
Kansas City, MO 64141
The member ID for a Medicare Advantage member will begin with a prefix of RRK or RKN.
The following medications or classes of medications require prior authorization. Medications may appear more than once. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings. Medications covered by a member's Medical Benefits are located under Medical Services/Medical Rx. This inlcudes Medicare Advantage Part D medications.
New-to-Market Medications
All new-to-market medications will require a prior authorization. If the medication you are looking for is a new-to-market drug, or is not listed, please select "general" as you submit your request.
Available Generics
Brand name drugs with an available generic requires the use of that generic. If there is a clinical reason the patient cannot use the generic, a Prior Authorization is required.
Pharmacy Medications That Require Prior Authorization
Pharmacy Medications for Members in Commercial & Affordable Care Act Plans (includes FEP & JAA)
Abilify Mycite (aripiprazole tables with sensor)
Aciphex Sprinkle (rabeprazole sodium)
Actemra Sub Q (tocilzumab)
Actiq (fentanyl )
Actonel (risedronate)
Actoplus Met/ XR (pioglitazone hcl and metformin hcl)
Actos (pioglitazone hydrochloride)
Adcirca (tadalafil)
Adderall XR (dextroamphetamine)
Addyi (fibanserin)
Adempas (Riociguat)
Admelog/ Solostar (insulin lispro)
Advair (fluticasone propionate)
Advair Diskus (fluticasone propionate)
Advair HFA (fluticasone propionate and salmeterol)
Aerospan (flunisolide)
Airduo Respiclick (fluticasone-propionate and salmeterol)
The member ID for someone in an ACA Individual Family Plan will begin with one of the following prefixes:
YBD, YBS, YBM, YBT, YBX, YJV, YJW, YJJ or YJT.
The member ID for a Medicare Advantage member will begin with a prefix of RRK or RKN.