Influenza Vaccine Coverage (2025-2026)
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Governs which influenza vaccines the Commonwealth of Kentucky Medicaid (Managed Care and Fee-for-Service) will cover for the 2025–2026 flu season and provides contact/prior authorization information for providers.
No material clinical or coverage changes in this revision.
Covered Influenza Vaccines (2025–2026)
Covered Influenza Vaccine Brands
Covered influenza vaccine brands for the 2025-2026 season (Kentucky Medicaid will cover the following):
Providers must consult the Kentucky Medicaid Vaccine List on the Kentucky Medicaid Provider Portal for the complete and authoritative list and any product-specific requirements.
No explicit exclusions are listed in this document. Providers should consult the Kentucky Medicaid Vaccine List on the Kentucky Medicaid Provider Portal for any product-specific exclusions or limitations.
There are no Not Medically Necessary (NMN) statements included in this notice.
Pharmacy / Claim Routing Identifiers
| BIN: 023880 / PCN: KYPROD1 / GROUP: KYM01 | Managed Care pharmacy claim routing identifiers |
| BIN: 026309 / PCN: KYPROD1 / GROUP: KYF01 | Fee-for-Service pharmacy claim routing identifiers |
Prior Authorization & Provider Next Steps
Prior authorization requirement
Prior authorizations for influenza vaccines must be obtained using the phone or fax contacts provided for the appropriate program (Managed Care or Fee-for-Service). Follow the listed PA procedures when requesting authorization.
- Managed Care prior authorization: Phone (844) 336-2676 [8:00AM - 7:00PM EST, 7 days/week]; Fax (858) 357-2612.
- Fee-for-Service prior authorization: Phone (877) 403-6034 [8:00AM - 7:00PM EST, 7 days/week]; Fax (858) 357-2612.
Use program-specific contacts and portal
Providers should use the program-specific contacts and portal resources listed in this notice for program questions, pharmacy help, and prior authorization submissions to ensure correct processing.
- Managed Care program questions: KYMCOPBM@MedImpact.com; Pharmacy Help Desk: (800) 210-7628 (24/7).
- Fee-for-Service program questions: KYMFFS@MedImpact.com; Pharmacy Help Desk: (877) 403-6034 (24/7).
- Pharmacy Portal (provider documents and portal access): https://kyportal.medimpact.com/
Kentucky Medicaid Vaccine List (authoritative product list)
The definitive list of covered influenza vaccine products for the 2025–2026 season is maintained on the Kentucky Medicaid Vaccine List available on the Kentucky Medicaid Provider Portal.
- Access the Kentucky Medicaid Vaccine List at: https://kyportal.medimpact.com/provider-documents/drug-information
Prior authorization contact/process — follow PA phone/fax procedures to avoid delays
Failure to follow the listed prior authorization phone/fax procedures or to use the correct program contacts may delay or prevent authorization and processing of influenza vaccine claims.
- Managed Care prior authorizations: Phone (844) 336-2676; Fax (858) 357-2612.
- Fee-for-Service prior authorizations: Phone (877) 403-6034; Fax (858) 357-2612.
- Use the pharmacy portal for documents and submission guidance: https://kyportal.medimpact.com/
Policy Background
This notice identifies which influenza vaccine brands the Commonwealth of Kentucky Medicaid will cover for the 2025–2026 influenza season. The listed brands include: Afluria, Fluad, Fluarix, Flublok, Flucelvax, Flulaval, Fluzone, and Fluzone High‑Dose. Providers should consult the Kentucky Medicaid Vaccine List on the Kentucky Medicaid Provider Portal for the definitive, authoritative list of covered products and any product‑specific requirements.
Key Definitions
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