If you or a family member have coverage through South Carolina Healthy Connections Medicaid, you may receive a review form soon. Learn how to keep your benefits on our
South Carolina Medicaid: Prescription coverage
Humana Healthy Horizons® in South Carolina members have prescription coverage. Learn about your coverage, how your doctor picks the medicine you can take, and more.
Prescription medicine
Humana Healthy Horizons in South Carolina members can access a full range of safe and effective medicines. These medicines are part of a formulary (also known as a Comprehensive Drug List). The medicines on the Comprehensive Drug List are available at no cost to you.
Comprehensive Drug List (CDL)
Your doctor will use the Comprehensive Drug List to choose the best medicine to treat you and your condition.
Some covered medicines may have extra steps you need to take or limits on what is covered. You may need to get approval (also known as prior authorization) for certain medicine.
We will cover your use of a medicine from the Comprehensive Drug List as long as there is a medical need for you to be on it. You also need to fill your prescription at a Humana network pharmacy and follow other plan rules.
The Comprehensive Drug List may change during the year. If any medicine of the Comprehensive Drug List changes, we will notify you. You always can refer to the below versions of the Comprehensive Drug List to see the current version.
Prior authorization
You may need to get approval (also known as prior authorization) for certain medicine. Whether a medicine needs this approval or not may change. The Comprehensive Drug List has information about the medicine that needs prior authorization. Only your doctor can send us a prior authorization request for you. We will let your doctor know our decision within 24 hours of getting the request.
Participating pharmacies
You can fill your prescription at any pharmacy that accepts Humana Healthy Horizons. Use our online
When you go to a pharmacy, make sure to bring your member ID card with you. As a Humana Healthy Horizons in South Carolina member, you can use Humana’s mail-order pharmacy, CenterWell Pharmacy®, which will send medicine to your home.
If you need medicine to treat a complex or long-lasting condition like cancer, HIV, or multiple sclerosis, for example, you may need to get your prescription filled at a specialty pharmacy. Medicines to treat complex or long-lasting conditions only may be available at certain locations.
You may be able to fill your specialty prescriptions at our CenterWell Specialty Pharmacy. This pharmacy will fill and mail your specialty prescription to your home or provider.
Over-the-counter health and wellness
Your pharmacy benefit lets you order certain over-the-counter (OTC) health and wellness items through the mail. These medicines will be sent by UPS or the U.S. Postal Service within 10–14 working days after the order is made. There is no charge to you for shipping.
You will get the generic versions of the OTC items you order. Generic medicine is the same as a brand-name medicine in:
- Dosage
- Effectiveness
- How to take the medicine
- How the medicine works
- Quality
- Safety
- Stability
- Strength
You have a $30/quarter allowance to spend on OTC health and wellness items.
You can find a full list of the OTC health and wellness items that you can get in the mail on the OTC order form below.
If you have questions about this mail-order service, call CenterWell Pharmacy at 800-379-0092 (TTY: 711), Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. to 6:30 p.m., Eastern time.
Lock-in program
We designed our lock-in program to help our members who take several prescription medicines. If you qualify for the program, and to make filling your prescriptions as easy as possible, we will work with you and your provider to have your prescriptions transferred to one pharmacy.
For answers to any questions:
-
Call: 855-330-8054 (TTY: 711), Monday – Friday, 8 a.m. – 5:30 p.m., Eastern time
-
After hours, please leave a voicemail with:
- Member name
- Humana member ID number
- Case number (if applicable)
- Contact phone number
- Detailed description of your question and/or request
-
After hours, please leave a voicemail with:
- Fax: 855-729-9290
- Email:
pharmacyclaimauditandreview@humana.com
If you pay for medicine
We hope you don’t have to pay out of pocket for covered medicines. If you do, please let us know. Send us a completed reimbursement form, and you may get a refund.