New prescription prior authorization process

Blue Cross and Blue Shield of Kansas (BCBSKS) is committed to providing our members with access to high-quality health care that is consistent with evidence-based, nationally recognized clinical criteria and guidelines. Therefore, we are updating how we manage certain medications under the medical benefit effective Aug. 15, 2025. 

Why it matters:  Beginning Aug. 7, 2025, providers should begin requesting prior authorizations from Prime Therapeutics (Prime) for in-scope drugs with dates of service on or after Aug. 15, 2025.

For providers currently requesting medical benefit drug reviews with the Prime Pharmacy Benefit Management Team via CoverMyMeds and/or fax, this will represent a change in workflow. Providers will begin submitting medical benefit drug reviews for these in-scope drugs to Prime’s Medical Pharmacy Solutions team by navigating to GatewayPA.com, or via phone at 800-424-1713. Drugs that are typically self-administered by the patient will continue to be requested through CoverMyMeds and/or fax.

Prior authorization will be required for selected medical drugs administered in: 

• Physician office (POS 11)
• Patient homes (POS 12)
• Outpatient facilities (POS 19, 22)
• Inpatient-CAR-T (21)

Learn more: Join us for a 60-minute, web-based training session presented by the Prime team of experts and become familiar with:

• The policies and procedures for this new program.
• What medical benefit drugs will require prior approval.
• How to obtain access to the Prime website.
• How to complete prior authorization requests using easy-to-use online tools from Prime.

It is recommended that you reserve your spot in one of these education sessions at least one week ahead of time. You will receive a registration confirmation email from Prime for the webinar session you select.

We appreciate your support in ensuring that our members continue receiving high-quality, clinically appropriate care. If you have questions, please contact your BCBSKS Provider Relations Representative.