MedicaidPrior AuthMedium impact
Updated Prior Authorization Expansion on Physician-Administered Drugs
SC Medicaid - SCDHHS·SC·Prior Authorization
Effective date
Nov 15, 2025
We identified it
Jun 18, 2026
Summary
South Carolina Medicaid is expanding prior authorization requirements for additional physician-administered drugs for fee-for-service Medicaid members effective November 15, 2025. Prior authorization requests must be submitted to Prime Therapeutics Management through their online portal or phone system.
Action Required
Before November 15, 2025: Billing team must review the updated list of physician-administered drugs requiring prior authorization in the SCDHHS Physicians Services Provider Manual. Update billing system to flag these medications for prior auth verification before administration to South Carolina fee-for-service Medicaid patients. Train staff to submit PA requests through gatewaypa.com or call 1-800-424-8219. Claims will be denied without proper prior authorization.