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South Carolina Pharmacy Services

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Pharmacy Documents

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Forms

Title
Title
Prior Authorization Request Form: Medications
Antipsychotic - Children ≤ 6 Years of Age PA Request Form
Growth Hormone PA Request Form - Adult Treatment
Growth Hormone PA Request Form - Pediatric Treatment
Health Insurance Referral Form
Hepatitis C PA Request Form
MAC Price Research Request Form
Universal Synagis Authorization Form

Listings

Title
Title
Pharmacy Error Codes
Pharmacy TPL Codes - Sorted by Name
Pharmacy TPL Codes - Sorted by Code

Manuals

Title
Title
Medicaid Provider Manual - Pharmacy Point of Sale
Medicaid Provider Manual - Pharmacy Services
Medicaid Payer Specifications - Pharmacy Services

Pricing Information

Title
Title
Mercer SC Average Acquisition Cost (AAC) List
Maximum Allowable Cost (MAC) Listing (updated the 9th of the month)
Maximum Allowable Cost (MAC) Listing - Weekly Changes (updated every Thursday)