MedicaidPrior AuthMedium impact
Updated Prior Authorization Expansion on Physician-administered Drugs
SC Medicaid - SCDHHS·SC·Prior Authorization
Effective date
Mar 1, 2026
We identified it
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.
Action Required
By March 1, 2026: Review the updated list of physician-administered drugs requiring prior authorization in the SCDHHS Physician Services Provider Manual. Update billing workflows to verify prior authorization status before administering covered drugs to South Carolina fee-for-service Medicaid patients. Train staff to submit PA requests through https://gatewaypa.com or call (800) 424-8219. Claims for non-authorized drugs will likely be denied.