Prior Authorization in South Carolina
South Carolina enacted S. 290 (2022) establishing step therapy override protections. The law requires insurers to grant exceptions for contraindications, prior failures, and expected inefficacy. SC mandates PA decisions within standard timeframes and provides external review.
Key Facts About PA in South Carolina
- ✓ Step therapy override protections enacted in 2022
- ✓ PA decisions must be communicated within reasonable timeframes
- ✓ External review available through the SC Department of Insurance
- ✓ Blue Cross Blue Shield of South Carolina is the dominant carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in South Carolina
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these South Carolina carriers:
BCBS of South CarolinaUnitedHealthcareAbsolute Total Care (Centene)Molina