South Carolina Pharmacy Services

Health Advisory - H1N1

South Carolina Department of Health and Environmental Control (SCDHEC) has issued a health advisory regarding the H1N1 virus. View details.

Web PA

South Carolina Medicaid offers Pharmacy Web Prior Authorization (Web PA), a web-based application developed by First Health Services Corporation (FHSC) which allows prescribers to request PAs online and receive real-time approvals. Web PA is offered in addition to a telephone call or fax to request a PA. It offers a wide array of features including electronic submission of a prior authorization request, ability to view the status of a PA, an option to edit or delete incomplete requests, access to list of drugs that require a prior authorization, and a secure transaction of confidential information to comply with HIPAA guidelines.

Note: Prior to obtaining access to the Pharmacy Web Prior Authorization tool, prescribers or the designated delegated administrator must access the User Administration Console (UAC) to request a personal identification number (PIN), register with the PIN, and create a user id/ password. Now is the perfect opportunity to access the User Administration Console by clicking on the UAC link in the upper right hand corner of this screen. There are instructions, educational documents, and online presentations available in the Reference collection link in the upper right hand corner of this screen. First Health Services also provides a Web Support Call Center (800-241-8726) for assistance with any questions you may have during this process.

Hepatitis C Program

To improve patient compliance and clinical outcomes, South Carolina Medicaid has implemented a specialty care management program for beneficiaries receiving certain specialty medications. The major focus of this program is to provide outreach to a population of South Carolina Medicaid beneficiaries who will receive high intensity intervention services to improve their care and outcomes. This program, administered by First Health Services Corporation, assists beneficiaries in an attempt to avoid duplication of existing services and serves as a “safety net” to identify any problems that may have occurred during the first level of services. With this initiative, beneficiaries are identified by the approval of a PA for a Hepatitis C treatment agent. Once enrolled in the program, beneficiaries will be contacted and educated on any medical or non-medical issues related to their disease or drug therapy, monitored for potential adverse reactions, reminded of refills to insure compliance with their drug therapy regime and assisted with transportation issues if necessary.

Prescription Limits

Effective January 1, 2009, SC Medicaid will no longer allow overrides or PAs beyond 6 additional prescriptions per month under the fee for service program. Adult SC Medicaid beneficiaries are allowed 4 standard prescriptions per month for non-overrideable drugs and six prescription overrides for drugs that meet specific override criteria. Requests to exceed the override limit of six will no longer be approved. The total number of prescriptions allowed will be 10 per month in the fee for service program for adult beneficiaries.

Note: Children from birth to the date of their 21st birthday are eligible for an unlimited number of Medicaid-covered prescriptions per month.

Tamper Resistant Prescriptions

All written, non-faxed, non-electronic or non-verbal prescriptions must be written on a tamper resistant form for coverage by Medicaid fee for service programs. All blanks must meet all three requirements for tamper resistant qualification. For full details, see Medicaid Bulletins dated August 30, 2007 and October 1, 2007. Answers to frequently asked questions regarding this requirement may be found at http://www.cms.hhs.gov.