ExchangePrior AuthMedium impact
Update to Pharmacy Benefit Drug Prior Authorization Process for Exchange Members
BlueCross BlueShield of South Carolina·SC · Pharmacy·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Aug 11, 2026
Summary
Beginning April 1, 2026, BlueCross BlueShield of South Carolina will internally manage non-specialty drug prior authorization requests for Exchange members, replacing OptumRx. This change affects Exchange plans with group numbers starting with 61, 62, or 65. Pharmacies and prescribers must submit PA requests through CoverMyMeds (ePA), phone, or fax using new contact information and updated forms.
Action Required
By March 31, 2026: (1) Billing and pharmacy teams must register for free CoverMyMeds (CMM) accounts and familiarize staff with the ePA portal submission process. (2) Update internal workflows and systems to route all non-specialty drug PA requests for BlueCross BlueShield Exchange members (group numbers 61, 62, 65) to CMM as the primary submission method. (3) Remove OptumRx from pharmacy PA request routing for these Exchange members. (4) Post updated contact information (Phone: 833-494-2987, Fax: 803-462-5000) in clinical and billing areas. (5) Train providers and pharmacy staff that CMM is the preferred ePA method; phone and fax are backup options. Failure to transition workflows by April 1, 2026 will result in delayed or rejected PA requests and potential claim denials.