Summary of Pharmacy Services

Pharmaceutical services provide First Choice members with needed pharmaceuticals as ordered through valid prescriptions from licensed prescribers for the purpose of saving lives in emergency situations or during short term illness, sustaining life in chronic or long-term illness or limiting the need for hospitalization. Members have access to most national chains and many independent pharmacies.

• Medications are generally prescribed to cover a maximum 31-day supply, except for allowable 90-day supply medications. Use the Searchable comprehensive drug list to determine if a 90-day supply is allowed. Pharmacy benefits are managed through PerformRx
• Pharmacy benefits are managed through PerformRx
• Direct pharmacy claims questions (technical online processing) to Argus at 1-800-522-7487
• Prior authorization and other pharmacy services related questions should be directed to Select Health/AmeriHealth Caritas Pharmacy Services at 1-866-610-2773 or faxed to 1-866-610-2775.

Over-the-counter drugs

All members are covered for certain over-the-counter (OTC) drugs with a prescription written by a doctor. Products will be dispensed generically when available.

Our Searchable Comprehensive Drug List can help you find specific coverage information for OTC medicines.

Co-payments

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

Preferred drug list

Select Health follows the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List. The PDL represents therapeutic recommendations based on documented clinical efficacy, safety and cost-effectiveness. All non-preferred medications will require prior authorization. Trial and failure of TWO preferred products is required to receive a non-preferred product unless only one preferred product is listed, or it is otherwise indicated on the state's PDL. Requests for prior authorization medications should be directed to Select Health/AmeriHealth Caritas Pharmacy Services at 1-866-610-2773 or faxed to 1-866-610-2775.

Download a copy of the SCDHHS Preferred Drug List.

Prior authorization

In a continuing effort to improve patient care and pharmaceutical utilization, Select Health, in conjunction with its pharmacy benefit manager, PerformRx^℠, has implemented a prior authorization program for the initial prescription of certain medications. Requests for medications that require prior authorization should be directed to Pharmacy Services at 1-866-610-2773 or faxed to 1-866-610-2775.

Note: For medications that require prior authorization, members may receive 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 prescription number. 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.

Appeal of prior authorization denials

Prior authorization denials may be appealed. Please see the section of our provider manual entitled "Medical Review Determination" to review the appeal process.