MedicaidPrior AuthMedium impact
Updated Prior Authorization Expansion on Physician-administered Drugs
SC Medicaid - SCDHHS·SC·Prior Authorization
Effective date
Aug 1, 2025
We identified it
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.
Action Required
By August 1, 2025: Billing team must review the updated list of physician-administered drugs requiring prior authorization on the SCDHHS Physicians Services Provider Manual website. Update billing system to flag these drugs for prior auth verification before administration to South Carolina fee-for-service Medicaid patients. Submit prior authorization requests to Prime Therapeutics at https://gatewaypa.com or call 1-800-424-8219. Claims for these drugs will be denied without proper prior authorization.