Effective January 1, 2016, the SC Public Employee Benefit Authority (PEBA) has contracted with a new prescription vendor, Express Scripts. As a result, some changes may have been made to the list of covered drugs, as well as the preauthorization process for your medications. Please review the information below to determine any steps you may need to take.
List of Covered Drugs
Express Scripts has issued an updated list of preferred drugs which means that some drugs that were considered “preferred” under the previous prescription vendor, may now be considered “non-preferred” under Express Scripts. If you are a State Health Plan member whose specific medication was impacted by this change, you should have received a notice regarding the currently covered drugs that were impacted as well as a list of alternative equivalent medications available at lower copays. Please share the list of basic covered drugs [pdf] with your doctor to determine if there is another drug comparable that you may be prescribed. You may still choose to use certain drugs that are covered differently from the current arrangement, but you will likely incur higher costs.
If you have medications that require a preauthorization, your physician’s approval is already on file and has been transferred to Express Scripts. You should not be required to provide another preauthorization until the current one on file expires. A preauthorization is generally effective up to 6 months, or as indicated by your physician. The process for authorizing a medication may be different with Express Scripts. However, Express Scripts will guide you through this process. If your physician prescribes a higher dosage or quantity for a medication than what is customary, additional authorization may be required.
If you have any questions regarding these changes, please contact Express Scripts at 855-612-3128.
Posted January 20, 2016