Important update for providers:
Beginning February 1, 2026, providers must submit medical benefit PA requests through the Availity provider portal, as Molina no longer accepts fax submissions. Continue to follow the current pharmacy submission processes for pharmacy benefit PA requests. Do not submit pharmacy PA requests through the Availity provider portal.
Prior Authorization Policy
Some services require approval before they are provided. The South Carolina Medicaid Pre Service Review Guide includes:
PA requests should be submitted through the Availity provider portal.
Service prior authorizations
Office visits to participating (PAR) providers and referrals to in‑network specialists do not require prior authorization (PA).Emergency services also do not require authorization.
Molina requires PA for certain services. See which services need PA with the prior authorization lookup tool
Providers can request and manage authorizations via Availity Essentials
Pharmacy prior authorizations
Molina works to provide appropriate and cost-effective drug therapy to all members covered by the Molina pharmacy program. If a member requires medication that does not appear on the formulary, the prescribing provider can make a request for a non-preferred medication. For more information on pharmacy prior authorization