Updated Prior Authorization Expansion on Physician-administered Drugs

Effective for dates of service on or after Oct. 1, 2026, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the physician-administered drugs in the document linked below to ensure use is consistent with the medication's indication(s) and appropriate clinical guidelines. This change only applies to medications administered to Healthy Connections Medicaid members enrolled in the fee-for-service (FFS) Medicaid program.

The list of physician-administered drugs for which PA is required when administered to an FFS Medicaid member is available in the procedure codes section of the Physicians Services Provider Manual on the SCDHHS website. The list in the manual will be updated with the additional physician-administered drugs requiring PA beginning Oct. 1, 2026. The list of additional drugs is available here.

Requests for PA and questions about this bulletin should be submitted to Prime Therapeutics Management at https://gatewaypa.com or by calling (800) 424-8219 between 8 a.m.-5 p.m. Monday-Friday.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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