Drug Management

Many of our prescription drug plans have drug management programs. Members who are not sure which programs apply to them can log into My Health Toolkit® for their personal information. We base the Drug Management programs on FDA and manufacturer guidelines, medical literature, safety, accepted medical practice, appropriate use and benefit design.

  • Prior Authorization - We require prior authorization for certain drugs for most members. You will need to request and receive prior authorization before we cover these drugs. 
  • Quantity Management - We limit the amount of certain drugs we cover for most members. We provide medical necessity exceptions for some of these limits when you request and receive prior authorization for them.
  • Dose Management - We limit the number of doses of certain drugs we cover for most members.
  • Step Therapy - We require step therapy for certain drugs for most members. We provide medical necessity exceptions when you request and receive prior authorization for them.

Prior Authorization Requests

To request prior authorization for specialty drugs, providers should call Caremark's Prior Authorization department at 866-814-5506. On behalf of BlueCross BlueShield of South Carolina, Caremark assists in the administration of our prescription drug program. Caremark is an independent company that provides pharmacy benefits management. Providers can also fax requests to Caremark. We provide many of the specialty drug prior authorization fax forms online.

To request prior authorization for any other drug that needs it, providers should call Caremark at 800-294-5979. Or, providers can fax requests to Caremark. We provide many of the prior authorization fax forms online.

Providers can also fax a form request to Caremark at 888-836-0730. Your request should include the patient's name, ID number, date of birth, address, telephone number and the strength and name of the drug. You should also include your name, office address, telephone and fax number.

Electronic Prior Authorization Requests Now Available!

You and your staff can now submit electronic Prior Authorization (ePA) requests online for non-specialty drugs. You will receive an immediate response – either an approval or a message stating that your request requires additional review. The ePA tool is currently available from Allscripts. Access is free and sponsored by Caremark. On behalf of BlueCross BlueShield of South Carolina, Allscripts administers the electronic prior authorization program. Allscripts is an independent company that provides electronic prescribing and other related services. On behalf of BlueCross, Caremark administers the Drug Management programs. Caremark is an independent company that manages pharmacy benefits. To register with Allscripts, visit its website. (This link leads to a third party website. Allscripts is solely responsible for the contents and privacy policy on its site.)