CurrentmedimpactPolicy N/A

Kentucky Medicaid Pharmacy & Therapeutics Advisory Committee — Special Meeting Agenda (coverage criteria)

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Agenda for the Kentucky Medicaid Pharmacy & Therapeutics Advisory Committee special meeting describing items to be reviewed, new products, therapeutic class recommendations, and procedural details for attendees and stakeholders.

Policy Summary

Payermedimpact

PolicyKentucky Medicaid Pharmacy & Therapeutics Advisory Committee — Special Meeting Agenda

Policy CodePolicy N/A

Change TypeInformational agenda

Effective DateN/A

Next Review DateN/A

Key ActionProviders must consult the Kentucky PDL and PA criteria on the MedImpact KY portal for current prior authorization requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7New single products listed for review

9Therapeutic classes with recommended changes

40+Consent agenda classes (approx.)

Oct 14, 2025Meeting date

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CurrentmedimpactPolicy N/A

Kentucky Medicaid Pharmacy & Therapeutics Advisory Committee — Special Meeting Agenda (coverage criteria)

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Know when medimpact releases new policies or updates existing guidance.

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Policy Summary

Payermedimpact

PolicyKentucky Medicaid Pharmacy & Therapeutics Advisory Committee — Special Meeting Agenda

Policy CodePolicy N/A

Change TypeInformational agenda

Effective DateN/A

Next Review DateN/A

Key ActionProviders must consult the Kentucky PDL and PA criteria on the MedImpact KY portal for current prior authorization requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7New single products listed for review

9Therapeutic classes with recommended changes

40+Consent agenda classes (approx.)

Oct 14, 2025Meeting date

Action Items for Providers and Speakers

Prior Authorization

Check KY PDL and PA criteria

Consult the Kentucky Preferred Drug List (PDL) and current Prior Authorization (PA) criteria on the MedImpact KY provider documents page to determine prior authorization requirements applicable to Medicaid members before prescribing or submitting a PA request.

Note

Review MedImpact KY provider documents for updates

Review the MedImpact KY provider documents page for any additional program guidance, document updates, or forms that affect prescribing, authorization, or committee participation; ensure actions follow the current materials posted there.

Denial Risk

PDL/PA reference and denial risk

To view the most current PDL and PA criteria use the MedImpact KY provider documents page; failure to follow current PDL/PA criteria may result in noncoverage or denial of prior authorization.

Documentation Required

Public speaker registration (Speaker Request form)

Complete the Speaker Request form to request time during the public session; the form is on the Committee Information tab under Forms on the MedImpact KY site.

Location: Committee Information tab → Forms at https://kyportal.medimpact.com/provider-documents/pt-committee
Complete the Speaker Request form prior to the meeting to be scheduled for public session

Meeting Purpose and Context

This agenda documents a special called virtual meeting of the Kentucky Medicaid Pharmacy & Therapeutics Advisory Committee scheduled for Tuesday, October 14, 2025, 1:00 P.M. to 4:00 P.M. (Eastern). The meeting will be held via Microsoft Teams webinar and will review new products proposed for market, consider recommended changes to multiple therapeutic classes, and conduct a consent agenda for classes with no recommended changes.

Items listed for committee review include single-product submissions (examples on the agenda: Zelsuvmi, Vykat XR, Tryptyr, Andembry, Sephience, Anzupgo, and Ekterly), as well as therapeutic classes with recommended changes (for example, acne agents, antiemetics, CAM antagonists, immunomodulators for atopic dermatitis, stimulants, GLP-1 receptor agonists, oral antivirals, and COPD agents). The agenda also identifies a consent agenda grouping approximately 40+ therapeutic classes with no recommended changes to be voted on as a block.

Operational and participation details for providers and stakeholders are included: to view the most current Preferred Drug List (PDL) and Prior Authorization (PA) criteria providers should consult the MedImpact Kentucky provider documents page, and members of the public who wish to speak must complete the Speaker Request form on the Committee Information tab of the same portal.

New Products and Consent Agenda Items

Single product submissions (individual review)

ZelsuvmiNew product to be reviewed as a single product (Dermatologics: Topical Antiviral Agents)

Vykat XRNew product to be reviewed as a single product (Non‑PDL)

TryptyrNew product to be reviewed as a single product (Ophthalmic: Immunomodulators)

AndembryNew product to be reviewed as a single product (Non‑PDL)

SephienceNew product to be reviewed as a single product (Non‑PDL)

AnzupgoNew product to be reviewed as a single product (Immunomodulators: Atopic Dermatitis)

Ekterly