Pharmacy
Absolute Total Care is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Absolute Total Care members. Absolute Total Care covers prescription medications and certain over-the-counter medications with a written order from an Absolute Total Care provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
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Ambetter Pharmacy Requests **Will open into new window
Use our Medicaid Comprehensive Drug Lists for more information on the drugs that are covered:
All oncology-related chemotherapeutic drugs and supportive agents will require prior authorization from Evolent before being administered in a physician’s office, outpatient hospital, or ambulatory setting.
This process applies to both Medical Benefit (Buy and Bill Request) AND Pharmacy Services (Retail Pharmacy)
Pre-Approval Process
The requesting physician must complete an authorization request using one of the following methods:
- Log in to the Evolent Provider Web Portal.
- Call 1-888-999-7713 and select option 1, from 8 a.m. to 8 p.m. EST, Monday through Friday.
General Evolent Information
Medical Benefit Buy & Bill requests are for medications that will be administered by a provider.
Examples include:
– Infusions in a provider’s office/outpatient setting
– Medications that will be administered in a home setting
– Injectables
To ensure timely processing of prior authorization requests, all supporting clinical information is required. Clinical information includes but is not limited to labs, radiology, clinical notes and utilization of previous medication for step therapy. For chemotherapy medication requests, include regimen and anticipated dates of service.
Lack of clinical information may result in delayed and/or denial of prior authorization request.
Contact Information
– Prior Authorization Fax: 1-855-865-9469
– Prior Authorization Phone: 1-800-460-8988
Contact Information
– Prior Authorization Fax: 1-833-982-4001
– Prior Authorization Phone: 1-866-399-0928
General Pharmacy Information
- All opioids (excluding exemptions) will be limited to an initial seven (7) day supply.
2025 Comprehensive Drug List Updates
2024 Comprehensive Drug List Updates
- Drug List Updates - Effective January 1, 2024 (PDF)
- Drug List Updates - Effective March 1, 2024 (PDF)
- Drug List Updates - Effective July 1, 2024 (PDF)
SCDHHS implemented a single PDL for all participating Managed Care Organizations (MCOs).