South Carolina

Liver damage restrictions

Fee-For-Service (FFS) and two managed care organizations (MCOs), First Choice, and Healthy Blue, do not impose liver damage requirements. Three MCOs, Absolute Total Care, Humana Healthy Horizons, and Molina Healthcare, do not make hepatitis C coverage criteria publicly available.

Sobriety restrictions

FFS appears to require six months’ abstinence from alcohol and substances. First Choice requires the provider to attest that they have provided substance use counseling and offered referral for substance use disorder treatment. Healthy Blue does not appear to impose sobriety restrictions. Three MCOs, Absolute Total Care, Humana Healthy Horizons, and Molina Healthcare, do not make hepatitis C coverage criteria publicly available.

Prescriber restrictions

FFS appears to require that treatment be prescribed by or in consultation with a gastroenterology, infectious disease, or hepatology specialist. First Choice requires treatment to be prescribed by a specialist. Healthy Blue does not appear to impose prescriber restrictions. Three MCOs, Absolute Total Care, Humana Healthy Horizons, and Molina Healthcare, do not make hepatitis C coverage criteria publicly available.

Recommendations

• Eliminate sobriety and prescriber restrictions.
• Restore parity across FFS and MCOs and transparency regarding hepatitis C coverage criteria.