Prior Authorization Management for Medical Specialty Drugs Is Changing
Sep. 9, 2016
BlueCross BlueShield of South Carolina is committed to keeping you informed of changes that may affect your administrative processes. Please review the important information below regarding an upcoming change to prior authorization (PA) management for medical specialty drugs.
Effective Dec. 1, 2026, BlueCross will transition the PA management of medical specialty drugs from MBMNow to internal resources for our Marketplace, or ACA plans.
This change is intended to streamline the authorization review process and provide a more efficient experience for providers submitting requests for medical specialty drug services.
Plans Affected
This change applies to applicable BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan Marketplace plans currently utilizing MBMNow for medical specialty drug prior authorization review. The group number prefixes associated with these plans are 23, 27, 61, 62, 63, 65 and 68.
Review of Medical Specialty Drug Services
Beginning Dec. 1, 2026, BlueCross and BlueChoice® will manage the reviews of prior authorization requests for eligible medical specialty drugs that are currently reviewed through MBMNow.
The prior authorization requirements and covered services are not new; however, the review process will differ on or after the effective date. The process will continue to require clinical assessment questions and clinical documentation will be required to support medical necessity determinations.
How to Submit Prior Authorization Requests
Providers should submit applicable medical specialty drug prior authorization requests online through Cohere Health, which is accessible via My Insurance Manager℠.
If you have questions, please contact your Provider Relations Consultant.
Cohere Health and MBMNow are independent companies that assists BlueCross BlueShield of South Carolina with utilization management.