Many of our prescription drug plans have drug management programs for medications* dispensed by pharmacies. Many of the prior authorization forms and exception request forms (where appropriate) are below.
Please note: For medications provided by doctors and other health care providers, please use the forms on the Health Plans page.
We require prior approval for drugs included in our prior authorization program for most members.
We limit the amount we cover for medications included in the quantity management program for many members. We cover higher quantities for some medications, when medical necessity is documented.
We require a generic or over-the-counter alternative trial before we cover medications included in the step therapy program for most members. We waive this requirement when medical necessity is documented.
Providers who need a prior authorization form that is not available online should call Caremark's Prior Authorization department. On behalf of BlueCross BlueShield of South Carolina, Caremark assists in the administration of the program. Caremark is an independent company that provides pharmacy benefits management. For specialty drugs, call 866-814-5506. For all other drugs, call 800-294-5979. You can also fax a form request to Caremark at 888-836-0730.
The State Health Plan provides prescription drug coverage through Medco. On behalf of the State Health Plan, Medco assists in the administration of the program. Medco is an independent company that provides pharmacy benefit management. Call Medco at 800-211-1456 or visit Medco's website for more information. (This link leads to a third party website. Medco is solely responsible for the contents and privacy policy on its site.)
*The medication names listed above may be the registered or unregistered trademarks of independent third-party pharmaceutical companies. These trademarks are included for informational purposes only and are not intended to imply or suggest any third-party affiliation.
