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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:

General Evolent Information

Evolent FAQ (PDF)

 

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

Buy and Bill Authorization Request Form (PDF)

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

 

Cover My Meds Prior Auth Forms

Universal Retail Medication Prior Authorization Form (PDF)

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.

SCDHHS implemented a single PDL for all participating Managed Care Organizations (MCOs). 

SCDHHS Preferred Drug List (PDL)

 

The following link will direct you to the SCDHHS Pharmacy Services homepage, which houses Prior Authorization Criteria for sPDL Medication Classes, specifically Casgevy and Lyfgenia.

South Carolina Pharmacy Services