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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.
Medicaid member picks up prescription at pharmacy

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 Preferred Drug List). Medicines on this list are the medicines we prefer your doctor use when choosing the best medicines to treat you and/or any condition(s) you have.

Preferred Drug List (PDL)

Your doctor will use the Preferred 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 Preferred 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 PDL may change during the year. If any medicine of the PDL changes, we will notify you. You always can refer to the below versions of the PDL to see the current version.

2021 Preferred Drug List (English) , PDF opens new window

2021 Preferred Drug List (Spanish) , PDF opens new window

2022 Preferred Drug List (English) , PDF opens new window

2022 Preferred Drug List (Spanish) , PDF opens new window

Preferred Drug List changes (English) , PDF opens new window

Preferred Drug List changes (Spanish) , PDF opens new window

Preferred Drug List – Machine Readable File , PDF opens new window

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 Preferred 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.

How much you may pay for your medicines

Members ages 19 and older have a $3.40 copayment for medicines your doctor prescribes for you to take.

Members 18 and younger, federally recognized Native Americans, institutionalized individuals (e.g., persons in a nursing facility or ICF-IF), and pregnant members do not have a copayment on covered medicines.

Participating pharmacies

You can fill your prescription at any pharmacy that accepts Humana Healthy Horizons. Use our online Find a Pharmacy service to find an in-network pharmacy near you.

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, Humana 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 Humana Specialty Pharmacy®. This pharmacy will fill and mail your specialty prescription to your home or provider.

Learn more about Humana Specialty Pharmacy

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 $10/month 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.

Over-the-counter health and wellness catalog and order form (English) , PDF opens new window

Over the counter health and wellness catalog and order form (Spanish) , PDF opens new window

If you have questions about this mail-order service, call Humana Pharmacy at 1-855-211-8370 (TTY: 711).

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: 1-855-330-8054 (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
  • Fax: 1-855-729-9290
  • Email: pharmacyclaimauditandreview@humana.com

If you pay for medicine

We hope you don’t have to pay more than your $3.40 copayment for covered medicines. If you do pay more, please let us know. Send us a completed reimbursement form, and you may get a refund.

Prescription Drug Reimbursement Claim Form , PDF opens new window

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