Changes to Prior Authorization Review Process for Select Physician administered Drugs

The South Carolina Department of Health and Human Services (SCDHHS) today announced the prior authorization review for several physician-administered drugs will transition from a review process administered by KEPRO to a review process administered by Magellan Specialty (formerly ICORE). This change is effective Feb. 4, 2021, for the drugs listed below. Providers should continue to use the KEPRO prior authorization review process until Feb. 4, 2021.

The prior authorization requirement will be removed for Mvasi (Q5107) and Avastin (J9035) at this time and until further notice.

Beginning Feb. 4, 2021, providers may submit prior authorization requests to Magellan Specialty using any of the following methods:

• Providers may contact Magellan Specialty by calling (800) 424-8219
• Providers may fax requests to Magellan Specialty’s HIPAA-compliant fax line at (888) 656-6671
• Providers may submit requests through Magellan Specialty’s secure web portal at https://ih.magellanrx.com/

Authorization or denial for the drug will be communicated to the provider by Magellan Specialty. Failure to obtain approval prior to provision of services may result in a claim denial.

Please direct any questions or concerns regarding this bulletin to the SCDHHS Provider Service Center at (888) 289-0709. 

Thank you for your continued support of the South Carolina Medicaid Program.

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