Public Notice of Final Action for the Hemophilia Factor Transition

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding the hemophilia factor transition under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after March 1, 2023, SCDHHS will amend the South Carolina Title XIX State Plan to address the termination of the hemophilia program arrangement with the South Carolina Department of Health and Environmental Control (SCDHEC), at SCDHEC’s request, and move the current and ongoing fee-forservice (FFS) hemophilia/clotting factor (Factor) coverage to point of sale adjudication. This process will allow services to be provided by any willing provider who is enrolled as an FFS pharmacy provider with SCDHHS. Providers will be reimbursed utilizing the current reimbursement methodology.

Based on the action above, SCDHHS anticipates a cost savings of approximately $131,000 (total dollars) annually. This is based upon the current Centers for Medicare and Medicaid Services (CMS) approved reimbursement methodology for the FFS pharmacy benefit using the lesser than logic calculation, which is lowest of Wholesale Acquisition Cost (WAC) plus professional dispensing fee (PDF), Maximum Allowable Cost (MAC) plus PDF,

Actual Acquisition Cost (AAC) plus PDF, or Usual and Customary (U&C) plus PDF. Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding this action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at SCDHHS, Office of Health Programs, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.