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Updated Prior Authorization Expansion on Physician-administered Drugs
Act
by Aug 1, 2025
Effective date
Aug 1, 2025
Identified
Jun 18, 2026
Summary
Effective August 1, 2025, South Carolina Medicaid will expand prior authorization requirements for physician-administered drugs for fee-for-service Medicaid members. The billing team must obtain prior authorization through Prime Therapeutics for additional drugs that will be specified in an updated list on the SCDHHS website.
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What to do
by Aug 1, 2025 · 4 steps
01Billing team must review the updated list of physician-administered drugs requiring prior authorization on the SCDHHS Physicians Services Provider Manual website.
02Update billing system to flag these drugs for prior auth verification before administration to South Carolina fee-for-service Medicaid patients.
03Submit prior authorization requests to Prime Therapeutics at https://gatewaypa.com or call 1-800-424-8219.
04Claims for these drugs will be denied without proper prior authorization.
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 Nov 15, 2025 · Prior AuthorizationBrowse every SC Medicaid - SCDHHS change in the policy list