Hemophilia Factor Fee-for-Service Transition

Effective for dates of service on or after March 1, 2023, the South Carolina Department of Health and Human Services (SCDHHS) will discontinue the hemophilia program arrangement with the South Carolina Department of Health and Environmental Control (SCDHEC). Factor services may be provided by any fee-for-service (FFS) pharmacy provider who is enrolled with SCDHHS.

Pharmacy reimbursement utilizes the standard basis of payment for the FFS pharmacy benefit at the lowest of:

• The actual acquisition cost (AAC) plus a professional dispensing fee (PDF) of $10.50;
• The states’ maximum allowable cost plus a PDF of $10.50; or,
• The usual and customary charges to the general public.

Providers rendering care to Healthy Connections Medicaid members who are enrolled in FFS Medicaid should direct any questions related to this transition to the Magellan Medicaid Administration call center at (866) 254-1669. The call center is available 24 hours per day.

South Carolina’s Medicaid managed care organizations (MCO) are responsible for the coverage and reimbursement related to factor services for Healthy Connections Medicaid members who are enrolled in an MCO. Provider questions related to MCO-enrolled patients should be directed to each individual MCO.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.