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Updated Prior Authorization Expansion on Physician-administered Drugs
Act
by Mar 1, 2026
Effective date
Mar 1, 2026
Identified
Jun 18, 2026
Summary
South Carolina Medicaid is expanding prior authorization requirements for physician-administered drugs effective March 1, 2026. This change only affects fee-for-service Medicaid members and requires providers to obtain prior authorization through Prime Therapeutics Management before administering specified medications.
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What to do
by Mar 1, 2026 · 4 steps
01Review the updated list of physician-administered drugs requiring prior authorization in the SCDHHS Physician Services Provider Manual.
02Update billing workflows to verify prior authorization status before administering covered drugs to South Carolina fee-for-service Medicaid patients.
03Train staff to submit PA requests through https://gatewaypa.com or call (800) 424-8219.
04Claims for non-authorized drugs will likely be denied.
Original notice
Updated Prior Authorization Expansion on Physician-administered Drugs
scdhhs.gov · Always check the source before changing claims.
Related changes
See all SC Medicaid - SCDHHS changes →Updated Prior Authorization Expansion on Physician-administered DrugsMediumEffective Dec 15, 2026 · Prior AuthorizationUpdated Prior Authorization Expansion on Physician-administered DrugsHighEffective Oct 1, 2026 · Prior AuthorizationUpdated Prior Authorization Expansion on Physician-administered DrugsHighEffective Jul 1, 2026 · Prior AuthorizationUpdated Prior Authorization Expansion on Physician-administered DrugsMediumEffective Aug 1, 2025 · Prior AuthorizationBrowse every SC Medicaid - SCDHHS change in the policy list