Drug Management

Many of our prescription drug plans have drug management programs. This means some prescriptions for some drugs need prior authorization before we will cover them. Not all benefit plans are the same. And drug management program requirements are not the same for all members.

  • To request prior authorization for most drugs, providers should call Caremark's Prior Authorization department at 800-294-5979. On behalf of BlueCross BlueShield of South Carolina, Caremark assists in the administration of our prescription drug program. Caremark is an independent company that provides pharmacy benefits management.
  • Providers can also fax a form request to Caremark at 888-836-0730. Your request should include the patient's name, ID number, date of birth, address, telephone number and the strength and name of the drug. You should also include your name, office address, telephone and fax number.
  • For specialty drugs, providers should call Caremark at 866-814-5506. 

Prior Authorization

Most of our members need prior authorization for certain drugs. You can find out what these drugs are by viewing our Prior Authorization Drug List.

Quantity Management

This program limits the amount of certain drugs a member’s plan will cover. You can see which drugs have quantity limits by viewing our Quantity Management Drug List.

Dose Management

This program limits the doses of certain drugs a member’s plan will cover. You can see the drugs included in the program by viewing our Dose Management Drug List.

Step Therapy

Step therapy programs group drugs into two categories. Step One Drugs are safe, effective and affordable. Most people should try these drugs first. They often work as well as more expensive drugs, at a lower cost. Step Two Drugs are more expensive. You can see the drugs included in the program by viewing our Step Therapy Drug List.