Prescription Benefits

Copays

Starting July 1, 2024, all First Choice members will have a $0.00 copay, including for vaccines.

Prescription Medicines

Preferred drug list

First Choice follows the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List. If you have questions about prior authorization, call Member Services at 1-888-276-2020.

Your pharmacy will fill your prescriptions with the generic version when one is available, unless otherwise noted on the SCDHHS Preferred Drug List. Sometimes brand-named medicines are preferred over generic medicines, or you may be required to try one or two preferred medicines before you can be prescribed non-preferred medicines based on South Carolina Medicaid guidelines.

Generic drugs are as good as brand-name drugs. They are approved by the FDA. To be approved, they must have the same active ingredient, strength, and form, and act the same in your body as the brand-name medicine. Generic medicines must be made to the same strict standards as the brand-name medicine. They may have a different color and shape, but these are the only differences.

There are some drugs that are not listed on the preferred drug list but may still be covered. Use the Searchable Comprehensive Drug List to find out if your medication is covered.

Limits on medicines

• You can get a maximum 90-day supply of maintenance medicines. Maintenance medicines treat conditions like asthma, high blood pressure and diabetes.
• For most non-maintenance medicines, you can get a 31-day supply, unless your provider has noted otherwise on the prescription.
• Members may get an emergency supply of medicine that will cover them for 72 hours while a prior authorization request is pending. A member is permitted one temporary supply per medication. Inhalers, diabetic test strip and supplies, and creams or lotions are exceptions to the supply limit because of how they are packaged. For those medicines, the member may receive the smallest package size available.­

To see if your medications can be filled for a 90-day supply, look them up using our Searchable Comprehensive Drug List.

Over-The-Counter Medicines

First Choice covers all members for some prescription over-the-counter (OTC) drugs. You will get generic brands of OTC drugs, when available. Our Searchable Comprehensive Drug List can help you find specific coverage information for these OTC medicines.

Prior Approvals and Authorizations

Prior approval

You will need approval before you get some medical procedures and for some medicines. Your primary care provider (PCP) will ask for prior approval from First Choice. To find out if a medicine needs prior approval, please call Member Services at 1-888-276-2020.

Some prescriptions must be approved before you can get them filled. If a medicine needs prior approval, your doctor must complete a prior authorization form. See the SCDHHS Preferred Drug List for more information about covered medicines.

If the request is approved, a notice is sent to your doctor. You can then get your medicine.

If the request is denied, you will get a letter explaining why. If you don't agree with the denial, you can appeal the decision. To file an appeal, call Member Services at 1-888-276-2020.

Ask your doctor if your drug needs prior approval when your doctor gives you the prescription. Most medicines do not require approval.

Some medicines need prior approval. Members may get an emergency supply of medicine that will cover them for 72 hours while a prior authorization request is pending. A member is permitted one temporary supply per medication. Inhalers, diabetic test strip and supplies, and creams or lotions are exceptions to the supply limit because of how they are packaged. For those medicines, the member may receive the smallest package size available.

Call Member Services for complete information about covered medicines, the appeal process or a complete list of participating pharmacies.

For prior authorization and other pharmacy services questions, call Member Services at 1-888-276-2020.

Call Member Services at 1-888-276-2020 for more information about your prescription benefits.

Don't wait until you run out. Set up refill reminders in the member portal to help you stay on schedule.