Update to Multi-ingredient Compound Coverage Policy
The South Carolina Department of Health and Human Services (SCDHHS) will update its multi-ingredient compound coverage effective Jan. 1, 2025.
Multi-ingredient compounds are covered by SCDHHS if the individual ingredients of the compound are eligible for a federal rebate. Multi-ingredient compounds provide drug therapies that are not commercially available as a U.S. Food and Drug Administration (FDA)-approved product in the same dose, formulation and/or combination of ingredients.
Effective Jan. 1, 2025, all multi-ingredient compounds exceeding $250 will require prior authorization. Prescribers should call SCDHHS’ pharmacy benefit administrator, Prime Therapeutics’, clinical call center at (866) 247-1181 for prior authorization. The call center is open 24 hours per day, seven days per week. Pharmacy products prescribed for Healthy Connections Medicaid members who are enrolled in the Medically Complex Children (MCC) waiver program are exempt from prior authorization requirements for multi-ingredient compounds. Bulk powders used for compounding will also be covered for Medicaid members enrolled in the MCC waiver program.
Hydroxyurea powders will continue to be covered without prior authorization requirements for the treatment of sickle cell disease.
South Carolina Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in their plan.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.