Any preferred drug list program implemented by the department must include:
(1) procedures to ensure that a request for prior authorization that has no material defect or impropriety can be processed within twenty-four hours of receipt;
(2) procedures to allow the prescribing physician to request and receive notice of any delays or negative decision in regard to a prior authorization;
(3) procedures to allow the prescribing physician to request and receive a second review of any denial of a prior authorization request; and
(4) procedures to allow a pharmacist to dispense an emergency, seventy-two hour supply of a drug requiring prior authorization without prior authorization if the pharmacist:
(a) has made a reasonable attempt to contact the physician and request that the prescribing physician secure prior authorization; and
(b) reasonably believes that refusing to dispense a seventy-two-hour supply would unduly burden the Medicaid recipient and produce undesirable health consequences.
HISTORY: 2008 Act No. 353, Section 2, Pt 4.C.1, eff July 1, 2008.
Structure South Carolina Code of Laws
Chapter 6 - Department Of Health And Human Services
Section 44-6-10. Creation of commission; members; term; conflict of interests.
Section 44-6-30. Duties and limitations.
Section 44-6-35. Medicaid waiver protections.
Section 44-6-50. Contracts with other agencies; program monitoring.
Section 44-6-70. Preparation of state plan and resource allocation recommendations.
Section 44-6-80. Annual and interim reports.
Section 44-6-90. Promulgation of regulations; other agencies to cooperate with commission.
Section 44-6-100. Personnel of commission; duties; compensation.
Section 44-6-110. Medicaid providers; boundary clarification.
Section 44-6-115. Covered Medicaid pharmacy services.
Section 44-6-132. Legislative findings and intent.
Section 44-6-135. Short title.
Section 44-6-140. Medicaid hospital prospective payment system; cost containment measures.
Section 44-6-155. Medicaid Expansion Fund.
Section 44-6-160. Target rate of increase for net inpatient charges; excessive increases; penalties.
Section 44-6-200. Falsification of information; penalties.
Section 44-6-220. Notice requirements on nursing home admission applications.
Section 44-6-300. Child development services to be established.
Section 44-6-310. Expansion of existing child development services.
Section 44-6-320. Appropriations.
Section 44-6-400. Definitions.
Section 44-6-420. Enforcement actions; considerations; proportionality to violations.
Section 44-6-470. Fines; use of funds collected.
Section 44-6-530. Federal jurisdiction.
Section 44-6-540. Authority for rulemaking, and to ensure compliance with Medicaid participation.
Section 44-6-610. Citation of article.
Section 44-6-620. Definitions.
Section 44-6-630. Creation of GAPS program; purpose.
Section 44-6-650. Eligibility; benefits.
Section 44-6-660. Evaluation of cost effectiveness; annual report.
Section 44-6-720. Requirements for qualifying for undue hardship waiver.
Section 44-6-725. Promissory notes received by Medicaid applicant or recipient.
Section 44-6-1010. Pharmacy and Therapeutics Committee established; membership.
Section 44-6-1040. Preferred drug list program; procedures to be included.
Section 44-6-1050. Prior authorization for drug; refills; appeals.