MedicaidPrior AuthMedium impact
Continuity of Care (Revised)
Humana·SC·Medicaid
Effective date
May 12, 2025
We identified it
Jun 24, 2026
Summary
Humana revised its Medicaid Continuity of Care policy for South Carolina, allowing override of prior authorization, step therapy, and non-preferred edits for members stable on medications within 90 days of eligibility start. The policy excludes experimental/investigational uses and maintains utilization management for select high-risk medications.
Action Required
By May 12, 2025: Billing team must update prior authorization processes for South Carolina Medicaid members to allow continuity of care overrides when members are stable on requested medications, have compendia-supported diagnoses, and eligibility started within 90 days. Train staff to verify these criteria before submitting prior auth requests. Document member stability and diagnosis support in authorization requests.